Appendix S.: Anticoagulants
APPENDIX S.1. COUMADIN TITRATION AND DOSE FORMS
➢ warfarin (G) dosage initially 2-5 mg/day; usual maintenance 2-10 mg/day; adjust dosage to maintain
INR in therapeutic range:Venous thrombosis: 2.0-3.0
Atrial fibrillation: 2.0-3.0
Post
MI : 2.5-3.5Mechanical and bioprosthetic heart valves: 2.0-3.0 for 12 weeks after valve insertion, then 2.5-3.5 long-term
Pediatric: <18 years: not recommended
Coumadin Tab: 1*, 2*, 2.5*, 3*, 4*, 5*, 6*, 7.5*, 10*mg
Coumadin for Injection Vial: 2 mg/ml (2.5 ml)
Comment: Coumadin for Injection is for peripheral
IV administration only.
APPENDIX S.2. COUMADIN OVER-ANTICOAGULATION REVERSAL
➢ phytonadione (vitamin K) (G) 2.5-10 mg
PO orIM ; max 25 mgAquaMEPHYTON Vial: 1 mg/0.5 ml (0.5 ml), 10 mg/ml (1, 2.5, 5 ml)
Mephyton Tab: 5 mg
APPENDIX S.3. AGENTS THAT INHIBIT COUMADIN’S ANTICOAGULATION EFFECTS
| Increase Metabolism | Decrease Absorption | Other Mechanism(s) |
|---|---|---|
| azathioprine carbamazepine dicloxacillin (G) ethanol griseofulvin nafcillin pentobarbital phenobarbital phenytoin primidone rifabutin rifampin | azathioprine cholestyramine colestipol sucralfate | coenzyme Q10 estrogen griseofulvin oral contraceptives ritonavir spironolactone trazodone vitamin C (high dose) vitamin K |