Warfarin initiation nomogram

Day	INR	Warfarin dose (mg)
1		5
2		5
3	<1.5	10
	1.5-1.9	5
	2-3	2.5
	>3	0
4	<1.5	10
	1.5-1.9	7.5
	2-3	5
	>3	0
5	<2	10
	2-3	5
	>3	0
6	<1.5	12.5
	1.5-1.9	10
	2-3	7.5
	>3	0

This nomogram applies to warfarin initial dosing in an otherwise healthy adult without comorbidities that could affect warfarin metabolism. Evidence to support this nomogram was derived in a young, mostly male population with venous thromboembolism. Lower initial dosing may be appropriate for individuals who are frail, elderly, or malnourished; who have liver or kidney disease or heart failure; or who are receiving a medication known to increase warfarin sensitivity. Higher initial dosing may be appropriate for individuals who were previously receiving warfarin and had higher dose requirements. Refer to UpToDate topics on the use of warfarin and specific clinical indications for further details.

INR: international normalized ratio.

Reference:

Crowther MA, Harrison L, Hirsh MD. Reply: Warfarin: Less may be better. Ann Intern Med 1997; 127:332.

From Annals of Internal Medicine, Kovacs MJ, Rodger M, Anderson DR, et al, Comparison of 10-mg and 5-mg warfarin initiation nomograms together with low-molecular-weight heparin for outpatient treatment of acute venous thromboembolism. A randomized, double-blind, controlled trial, Volume 138, Issue 9, Pages 714-9. Copyright © 2003 American College of Physicians. All Rights Reserved. Reprinted with the permission of American College of Physicians, Inc.

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Warfarin initiation nomogram