Inpatient Coumadin consults

[ethyl]

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I'm accustomed to managing coumadin in an outpatient setting with small percentage adjustments in average doses per week. How aggressive are you when starting out new coumadin inpatients? Do you change your strategy when it comes to bridging someone with an active DVT on a heparin drip vs. someone with Afib and no thrombus?
The general guides on dosing let you pick from wide dose ranges depending on INR and the # of days into therapy, and everything seems like a crapshoot. Just wondering if anyone out there has gotten a good feel for their coumadin consults and if you have some clinical pearls.

 

[WVUPharm2007]

It's a crapshoot. I never really changed strategy based on specific indication (other than the obvious changes in desired INR ranges with prosthetic valves and such) They were always covered by hep or enox, anyway. Just followed the algorithm...I always used this method. It worked rather well, IMO.

 

[ucrx]

I'm accustomed to managing coumadin in an outpatient setting with small percentage adjustments in average doses per week. How aggressive are you when starting out new coumadin inpatients? Do you change your strategy when it comes to bridging someone with an active DVT on a heparin drip vs. someone with Afib and no thrombus?
The general guides on dosing let you pick from wide dose ranges depending on INR and the # of days into therapy, and everything seems like a crapshoot. Just wondering if anyone out there has gotten a good feel for their coumadin consults and if you have some clinical pearls.

My hospital has its own algorithm, but I think it is similar to the one WVU posted. The main thing our hospital emphasizes is avoiding loading doses. Warfarin also inhibits protein C and S and promotes coagulation at first, so it is important to remember to bridge patients when you need immediate effect. That is more important than the specific adjustments at my hospital.