soapnote.org » Cardiovascular » Coumadin adjustment calculator (2.5 mg tablets)

Coumadin adjustment calculator (2.5 mg tablets)

by Mark Morgan, MD on July 2, 2012

GD Star Rating
loading...

The new version of this coumadin calculator is at http://www.soapnote.org/cardiovascular/coumadin-calc/. Please update your links/embeds.

summary, references, & relevant links
Summary: This calculator guides a medical provider through adjustment of coumadin (warfarin) dosing using 2.5 mg tablets. For the same calculator with recommendations in 5 mg tablets, please go here.
Point-of-Care Guide and paper-based encounter form at Ebell (2005) Am Fam Physician 71: 1979-82.
University of Michigan Anticoagulation Management Service warfarin adjustment protocol.
Comprehensive article at Ansell (2001) Chest 119: 22S-38S.

—————————————————————————

BEGIN: There are two calculators, one for goal INR of 2 to 3 and one for goal INR of 2.5 to 3.5. Click on the appropriate link below to select which calculator.

CHOOSE: Calculator for INR goal 2 to 3 or Calculator for INR goal 2.5 to 3.5

—————————————————————————

-

—————————————————————————

INR goal 2 to 3

The new version of this coumadin calculator is at http://www.soapnote.org/cardiovascular/coumadin-calc/. Please update your links/embeds.
Current weekly dose (add up all days' doses)
Current INR
Number of consecutive weekly in-range INRs prior to this INR?
Bleeding?
- No significant bleeding
- Serious bleeding
- Life-threatening bleeding
INR < 1.5. Recommended increase is 10 to 20%
12.5 mg is the minimum weekly dose threshold to make a significant dosage change for this INR zone. You may consider manually adding a dose if necessary (see below).
INR 1.5 to 1.7. Recommended increase is 5 to 10%
25 mg is the minimum weekly dose threshold to make a significant dosage change for this INR zone. You may consider adding a dose if necessary (see below).
INR 1.8 to 1.9. Recommended increase is 5 to 10%
25 mg is the minimum weekly dose threshold to make a significant dosage change for this INR zone. At this zone, it is often appropriate to leave the dose unchanged and simply recheck in 7 to 14 days.
INR 2 to 3. No change is recommended
INR 3.1 to 3.2. Recommended decrease is 5 to 10%
25 mg is the minimum weekly dose threshold to make a significant dosage change for this INR zone. At this zone, it is often appropriate to leave the dose unchanged and simply recheck in 7 to 14 days.
INR 3.3 to 3.9. Recommended decrease is 5 to 10%
25 mg is the minimum weekly dose threshold to make a significant dosage change for this INR zone. You may consider manually subtracting a dose if necessary (see below).
INR 4.0 to 4.9. Recommendation is to hold for 0 - 1 day, then decrease 10%
25 mg is the minimum weekly dose threshold to make a significant dosage change for this INR zone. You may also consider manually subtracting a dose if necessary (see below).
INR 5.0 to 8.9. Recommendation is to hold for 1 - 2 days, decrease 10 to 20%, and consider vitamin K
12.5 mg is the minimum weekly dose threshold to make a significant dosage change for this INR zone. You may consider manually subtracting a dose if necessary (see below).
INR 9.0 or more. Recommendation is to hold warfarin therapy; give vitamin K1 5.0 to 10 mg orally; monitor frequently. Resume at lower dose when INR is therapeutic
Manual override: Add or subtract a 2.5 mg dose to new weekly total?
- No
- Add 2.5 mg dose
- Subtract 2.5 mg dose
At lower weekly doses and/or at zones close to the goal INR, occasionally the new recommended weekly dosage will be unchanged. Often this indicates that a dosage change is not warranted and retesting should be performed at the recommended interval. You can, however, manually change the recommended dose by adding or subtracting a dose. You may do so by making a selection above.

Result - Copy, Save, or Print this text:

Copy Print Save as PDF

-

INR goal 2.5 to 3.5

The new version of this coumadin calculator is at http://www.soapnote.org/cardiovascular/coumadin-calc/. Please update your links/embeds.
Current weekly dose (add up all days' doses)
Current INR
Number of consecutive weekly in-range INRs prior to this INR?
Bleeding?
- No significant bleeding
- Serious bleeding
- Life-threatening bleeding
INR < 1.5. Recommended increase is 10 to 20%
12.5 mg is the minimum weekly dose threshold to make a significant dosage change for this INR zone. You may consider manually adding a dose if necessary (see below).
INR 1.5 to 2.2. Recommended increase is 5 to 10%
25 mg is the minimum weekly dose threshold to make a significant dosage change for this INR zone. You may consider adding a dose if necessary (see below).
INR 2.3 to 2.4. Recommended increase is 5 to 10%
25 mg is the minimum weekly dose threshold to make a significant dosage change for this INR zone. At this zone, it is often appropriate to leave the dose unchanged and simply recheck in 7 to 14 days.
INR 2.5 to 3.5. No change is recommended
INR 3.6 to 3.7. Recommended decrease is 5 to 10%
25 mg is the minimum weekly dose threshold to make a significant dosage change for this INR zone. At this zone, it is often appropriate to leave the dose unchanged and simply recheck in 7 to 14 days.
INR 3.8 to 4.4. Recommended decrease is 5 to 10%
25 mg is the minimum weekly dose threshold to make a significant dosage change for this INR zone. You may consider manually subtracting a dose if necessary (see below).
INR 4.5 to 5.9. Recommendation is to hold for 1 - 2 days, then decrease 10%
25 mg is the minimum weekly dose threshold to make a significant dosage change for this INR zone. You may also consider manually subtracting a dose if necessary (see below).
INR 6.0 to 8.9. Recommendation is to hold for 1 - 2 days, decrease 10 to 20%, and consider vitamin K
12.5 mg is the minimum weekly dose threshold to make a significant dosage change for this INR zone. You may consider manually subtracting a dose if necessary (see below).
INR 9.0 or more. Recommendation is to hold warfarin therapy; give vitamin K1 5.0 to 10 mg orally; monitor frequently. Resume at lower dose when INR is therapeutic
Manual override: Add or subtract a 2.5 mg dose to new weekly total?
- No
- Add 2.5 mg dose
- Subtract 2.5 mg dose
At lower weekly doses and/or at zones close to the goal INR, occasionally the new recommended weekly dosage will be unchanged. Often this indicates that a dosage change is not warranted and retesting should be performed at the recommended interval. You can, however, manually change the recommended dose by adding or subtracting a dose. You may do so by making a selection above.

Result - Copy, Save, or Print this text:

Copy Print Save as PDF

Favorites

Email

Embed

Tagged as: anticoagulation, calculator, coumadin, warfarin

{ 1 comment… read it below or add one }

Mark Morgan, MD June 19, 2013 at 1:59 am: The new version of this coumadin calculator is at http://www.soapnote.org/cardiovascular/coumadin-calc/. Please update your links/embeds.

Log in to Reply

You must log in to post a comment.

Coumadin adjustment calculator (2.5 mg tablets)

INR goal 2 to 3

INR goal 2.5 to 3.5

Embed "Coumadin adjustment calculator (2.5 mg tablets)"