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
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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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