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Initial dose
Initiate anticoagulation with 5 mg/day of warfarin.
Check the INR after 1-3 days.
Start anticaogulation with 2.5 mg/day of warfarin and check the INR in 1-3 days
under the following circumstances:
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age greater than 60,
- weight < 50 kg,
- anemia,
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history of liver disease,
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history of CHF,
- recent beeding episode,
- history of falls,
- use of interacting drugs,
- recent surgery,
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malnutrition,
- NPO > 3 days,
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advance debility
Management of warfarin associated bleeding
Life threatening bleeding:
- PCC (prothrombin complex concentrate) 50 u/kg,
- Vitamin K 10 mg slow i.v.,
- Check INR in 6 hrs. and repeat Vit. K as necessary
Serious bleeding:
- Vit. K 10 mg slow i.v. In urgent supplement with:
- Fresh frozen plasma 15 ml/kg,
- PCC 50 U/kg,
- Check INR at 6 and 12 hrs. and repeat vit. K as necessary
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