title: A safe, effective, and easy to use warfarin initiation dosing nomogram for post-joint arthroplasty patients.
abstract: 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.
authors.affiliation: Department of Medicine, General Internal Medicine, University Healthcare Thrombosis Service, University of Utah, Salt Lake City, Utah 84132, USA.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Pendleton
authors.forename: Michelle
authors.initials: M
authors.lastname: Wheeler
authors.forename: Nathan
authors.initials: N
authors.lastname: Wanner
authors.forename: Michael B
authors.initials: MB
authors.lastname: Strong
authors.forename: Russell
authors.initials: R
authors.lastname: Vinik
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Peters
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D054556:Venous Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D014859:Warfarin