Document Detail

A safe, effective, and easy to use warfarin initiation dosing nomogram for post-joint arthroplasty patients.
MedLine Citation:
PMID:  19062248     Owner:  NLM     Status:  MEDLINE    
Venous thromboembolism (VTE) is a complication after joint arthroplasty, and pharmacologic prophylaxis is recommended to reduce this risk. Warfarin is often used, but initial dosing and management can be difficult. We studied a single-center prospective cohort of consecutive (n = 351) post-joint arthroplasty/revision patients who were initiated on warfarin using a new initiation nomogram and then discharged to home with home health services. The mean time to an international normalized ratio (INR) of 2.0 or higher was 5 days, with a mean INR of 2.1 on the fifth postoperative day. Two patients (0.6%) had an INR higher than 5 in the first 10 days of therapy. Adverse events were uncommon: 4 patients (1.14%) had VTE, 1 had major bleeding episode, and 6 patients (1.7%) had minor bleeding. A specific warfarin dosing nomogram managed by an anticoagulation service and used in joint arthroplasty/revision patients who are discharged to home with home health services leads to effective anticoagulation with few associated adverse events.
Robert C Pendleton; Michelle Wheeler; Nathan Wanner; Michael B Strong; Russell Vinik; Christopher L Peters
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Publication Detail:
Type:  Journal Article     Date:  2008-12-05
Journal Detail:
Title:  The Journal of arthroplasty     Volume:  25     ISSN:  1532-8406     ISO Abbreviation:  J Arthroplasty     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-02-01     Completed Date:  2010-04-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8703515     Medline TA:  J Arthroplasty     Country:  United States    
Other Details:
Languages:  eng     Pagination:  121-7     Citation Subset:  IM    
Copyright Information:
2010 Elsevier Inc. All rights reserved.
Department of Medicine, General Internal Medicine, University Healthcare Thrombosis Service, University of Utah, Salt Lake City, Utah 84132, USA.
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MeSH Terms
Aged, 80 and over
Anticoagulants / administration & dosage*,  adverse effects
Arthroplasty, Replacement, Hip* / adverse effects
Arthroplasty, Replacement, Knee* / adverse effects
International Normalized Ratio
Middle Aged
Venous Thromboembolism / etiology,  prevention & control*
Warfarin / administration & dosage*,  adverse effects
Young Adult
Reg. No./Substance:
0/Anticoagulants; 81-81-2/Warfarin

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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