Prospective Assessment of a Nomogram for the Initiation of Oral Anticoagulation Therapy for Outpatient Treatment of Venous ThromboembolismKovacs M.J.a · Anderson D.A.b · Wells P.S.c
aDepartments of Medicine,aLondon Health Sciences Centre, London, Ontario, bQueen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, cOttawa Civic Hospital, Ottawa, Ontario, Canada
Dr. Michael J. Kovacs
Room 2760, Phase 1, London Health Sciences Centre
800 Commissioners Road East
London, Ontario N6A 4G5 (Canada)
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Venous thromboembolism is a common medical problem. Recently, the emphasis has been on a switch to outpatient low molecular weight heparin therapy. Previous warfarin nomograms have been developed only for inpatients. We prospectively assessed a warfarin initiation nomogram in 105 consecutive outpatients; the nomogram requires International Normalized Ratio (INR) testing on only days 3, 5, and 8. Eighty-three percent had a therapeutic INR by day 5 and 98% by day 8. There were no major bleeds and only 6 instances of INR >4.5. This outpatient warfarin nomogram appears to be safe and efficacious in obtaining timely therapeutic levels of warfarin and deserves further study.
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