The patient should not double the dose the next day to make up for a missed dose.Some dental or surgical procedures may necessitate the interruption or change in the dose of COUMADIN therapy.
Target INR: 2.5 (range: 2 to 3) Duration of therapy: Indefinite. To ensure therapeutic anticoagulation, continue full dose heparin therapy and overlap COUMADIN therapy with heparin for 4 to 5 days and until COUMADIN has produced the desired therapeutic response as determined by INR, at which point heparin may be discontinued.As heparin may affect the INR, patients receiving both heparin and COUMADIN should have INR monitoring at least:• 5 hours after the last intravenous bolus dose of heparin, orCOUMADIN may increase the activated partial thromboplastin time (aPTT) test, even in the absence of heparin. 2. Warfarin takes 4-7 days to have its optimum effect. Select one or more newsletters to continue.
After stabilization, maintain dosing within the therapeutic range by performing periodic INRs. Consider the benefits and risks when discontinuing COUMADIN even for a short period of time. The duration of treatment is based on the indication as follows:In patients with non-valvular AF, anticoagulate with warfarin to target INR of 2.5 (range, 2.0-3.0).Oral anticoagulation therapy with warfarin has not been fully evaluated by clinical trials in patients with valvular disease associated with AF, patients with mitral stenosis, and patients with recurrent systemic embolism of unknown etiology. An INR of greater than 4.0 appears to provide no additional therapeutic benefit in most patients and is associated with a higher risk of bleeding.Table 1: Three Ranges of Expected Maintenance COUMADIN Daily Doses Based on CYP2C9 and VKORC1 Genotypes† We comply with the HONcode standard for trustworthy health information - If the patient’s CYP2C9 and VKORC1 genotypes are not known, the initial dose of COUMADIN is usually 2 to 5 mg once daily. Warfarin is given once daily. Initiate therapy with the estimated daily maintenance dose (2-5 mg.). Initial dose: 2 to 5 mg orally once a day. The dosage and administration of COUMADIN must be individualized for each patient according to the patient’s International Normalized Ratio (INR) response to the drug. Perform additional INR tests when other warfarin products are interchanged with COUMADIN, as well as whenever other medications are initiated, discontinued, or taken irregularly. 1.
Large loading doses do not markedly shorten the time to achieve a full therapeutic effect but cause rapid falls in the level of protein C, which may precipitate paradoxical thrombosis in the first few days of warfarin therapy. Large loading doses do not markedly shorten the time to achieve a full therapeutic effect but cause rapid falls in the level of protein C, which may precipitate paradoxical thrombosis in the first few days of warfarin therapy. Comments: -For patients with atrial fibrillation (AF) and prosthetic heart valves, target INR may be increased depending on valve type, valve position, and patient factors. When the INR falls below 2.0 thrombosis risk increases and when the INR rises above 4.0 serious bleeding risk increases.Warfarin takes 4-7 days to have its optimum effect. Monitor INR more frequently in patients with compromised renal function to maintain INR within the therapeutic range The anticoagulant effect of COUMADIN persists beyond 24 hours. Prothrombin times are reported in seconds, as a ratio of the prothrombin time in seconds to the mean normal prothrombin time of the laboratory, and as the international normalized ratio (INR). In patients undergoing minimally invasive procedures who must be anticoagulated prior to, during, or immediately following these procedures, adjusting the dosage of COUMADIN to maintain the INR at the low end of the therapeutic range may safely allow for continued anticoagulation.Since the full anticoagulant effect of COUMADIN is not achieved for several days, heparin is preferred for initial rapid anticoagulation.
Maintenance dose: 2 to 10 mg orally once a day. Elderly or debilitated patients often require low daily doses of wa… Determine each patient’s dosing needs by close monitoring of the INR response and consideration of the indication being treated.
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