Ortho Warfarin Dosing Protocol

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Presentation transcript:

Ortho Warfarin Dosing Protocol

Post-Op Venous Thromboembolism (VTE) VTE = Deep venous thromboembolism (DVT) and pulmonary embolism (PE) Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) are associated with the highest risk of DVT 8-70% of pts Fatal PE in 2-3% of pts without prophylaxis Can occur days to weeks after discharge

VTE Prophylaxis Options in Ortho Aspirin 325 mg PO BID Warfarin New Oral Anticoagulants Rivaroxaban Apixaban Dabigatran Enoxaparin Fondaparinux Low Dose Unfractionated Heparin

VTE Ortho At least 14 days of use Ideally 4 weeks

Warfarin Information Indications: - Treatment and prophylaxis of VTE Mechanism of Action: - Vitamin K Antagonist Dose: - Patient specific - Affected by other medications, genetic factors, etc Laboratory Monitoring: - PT/INR (Goals vary according to indication)

Warfarin Monitoring Every day the dose of warfarin given the previous day and INR are documented Alert MD if INR increased > 1, no INR in 72 hours, or INR > 3.5 Document in Direct Charting Hints: change to 24 hour view, check dose given Policy in docushare

Ortho Warfarin Dosing Protocol Nomogram to dose patients on warfarin after ortho procedures Dose is determined by change in INR Hints: Post-op Day 0: day of surgery Does not work if warfarin for any other indication Policy in Docushare