Recommended Therapeutic Range for Warfarin Therapy


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Recommended Therapeutic Range and Duration of Warfarin Therapy

Diagnosis

Target INR

Duration

Deep Vein Thrombosis (transient risk - 1st episode) (idiopathic – 1st episode) (recurrent VTE) (associated active malignancy)
Pulmonary Embolism (transient risk - 1st episode) (idiopathic- 1st episode) (at high risk or recurrent)
Hypercoaguable States Antiphospholipid Antibody Syndrome Antithrombin, protein C or protein S deficiency (transient risk - 1st
episode) Antithrombin, Protein C or protein S deficiency (idiopathic-1st episode) Factor V Leiden/Prothrombin gene Mutation Heterozygous Homozygous Elevated Factor VIII activity or hyperhomocysteinemia (transient risk -
1st episode) Elevated Factor VIII activity or hyperhomocysteinemia (idiopathic- 1st episode)
Prosthetic Heart Valves Aortic Position Mechanical (Caged-ball, Caged disk) Mechanical (Starr-Edwards, Bjork-Shiley) Mechanical (St. Jude) with atrial fibrillation (AF) Mechanical (Carbomedics bileaflet, Medtronic Hall tilting disk with
normal LA and sinus rhythm) Bioprosthetic
Mitral Position Mechanical (tilting disk or bi leaflet) Bioprosthetic
Mechanical valve + AF, myocardial infarction, LA enlargement, endocardial damage or low EF Mechanical valve + systemic embolism
Transient Ischemic Attacks (TIA’s) Despite antiplatelet therapy
Atrial Fibrillation (AF) Chronic or intermittent Peri-Cardioversion
Dilated Cardiomyopathy (LVEF ≤ 28%) with previous thromboembolism(TE)or AF LV thrombus Rheumatic Mitral Valve Disease
after TE event or left atrium > 5.5 cm Stroke
Embolic causes Non-embolic causes

2.0-3.0
2.0-3.0
2.0-3.0 g 2.0-3.0
2.0-3.0 2.0-3.0
2.0-3.0 2.0-3.0
2.5-3.5 + Aspirina 2.5-3.5 or 2.0-3.0b
2.0-3.0 c 2.5-3.5
2.0-3.0 2.0-3.0 or Aspirinc 2.5-3.5 e or 2.0-3.0b
2.0-3.0 2.5-3.5 + Aspirina 2.5-3.5 + Aspirina
2.0-3.0
2.0-3.0 2.0-3.0
2.0-3.0
2.0-3.0 ASA or clopidogrel

3 months At least 6-12 months*
Indefinite Until remission
3-6 months At least 6-12 months*
Indefinite
Indefinite
At least 6-12 months*
Indefinite
At least 6-12 months* Indefinite
At least 6-12 months*
Indefinite
Indefinite Indefinite Indefinite Indefinite Indefinite
First 3 months d
Indefinite First 3 months d
Indefinite Indefinite Clinical judgment
Indefinite 3 weeks before+ 4 weeks after f
Indefinite At least 3 months
Indefinite
Indefinite Indefinite

a) Aspirin 80-100 mg/day b) If add aspirin 80-100 mg/d to warfarin anticoagulation c) If normal left atrial size and patient in sinus rhythm. Use of aspirin versus warfarin for the first 3 months post-op after aortic bioprosthesis implantation is a matter of clinical judgment. Whether warfarin offers superior protection from thromboembolic events remains unclear. d) Lifelong aspirin 325mg daily should be given thereafter. e) If at high risk or TE event, may add aspirin 80-100 mg/day f) Adequately anticoagulate for 3 weeks prior to cardioversion and 4 weeks after return to normal sinus rhythm. g) Higher intensity therapy may be warranted based on patient history and clinical judgment.

*Consider long-term low-intensity (INR 1.5-2.0) or standard intensity (INR 2-3) warfarin therapy for patients with idiopathic events.

Adapted from Haines ST. Recommended Therapeutic Range for Warfarin Therapy – ASHP Anticoagulation Service Traineeship 2002. Page 3. Adapted from Buller et al. Chest 2004;126:401S-428S. and Singer DE et al. Chest 2004;126:429S-456S. and Salem DN et al. Chest 2004;126:457S-482S. and Albers GW et al. Chest 2004;126:483S-512S Adapted from Anand S and Yusuf S. Oral anticoagulants in patients with coronary artery disease. J Am Coll Cardiol 2003; 41: 62S-69S.

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Recommended Therapeutic Range for Warfarin Therapy