Medicamentsen-ligne vous propose les traitements dont vous avez besoin afin de prendre soin de votre santé sexuelle. Avec plus de 7 ans d'expérience et plus de 80.000 clients francophones, nous étions la première clinique fournissant du
acheter levitra original en France à vente en ligne et le premier vendeur en ligne de Cialis dans le monde. Pourquoi prendre des risques si vous pouvez être sûr avec Medicamentsen-ligne - Le service auquel vous pouvez faire confiance.
May 15 pointofcare.pdf
Figure 1. Warfarin Dose Reminder Chart
Your doctor has highlighted a row below showing the total amount of warfarin (Coumadin) you should take each week. Look at the highlighted row and find the number under today’s day of the week. Take that number of 5-mg warfarin tablets at approximately 5 p.m.
Number of 5-mg tablets to take on each day of the week
NOTE TO THE PHYSICIAN: The initial total weekly dose (first column) can be derived using the nomogram published in: Ebell MH. Evidence-based initiation of warfarin (Coumadin). Am Fam Physician 2005;71:763-5; available online at: http://www.aafp.org/afp/20050215/poc.html.
Chart developed by Mark H. Ebell, MD, MS, Michigan State University College of Human Medicine, East Lansing. Copyright 2005 American Academy of Family Physicians. Physicians may photocopy or adapt for use in their own practices; all other rights reserved. “Point-of-care Guides.” Ebell MH.
American Family Physician. May 15, 2005;71:1979-82. Accessible online at: http://www.aafp.org/afp/20050515/pocform.html.
treatment compared with primary care management. J Clin Pathol
6. Dalere GM, Coleman RW, Lum BL. A graphic nomogram for warfarin
dosage adjustment. Pharmacotherapy 1999;19:461-7.day, and one and
5. Ansell J, Holden A, Knapic N. Patient self-management of oral antico-
one half 5-mg tablets on Monday and Friday). Her INR today is 3.6.
agulation guided by capil ary (fingerstick) whole blood prothrombin
Looking back, her INR trend was gradual y upward; her last value was
times. Arch Intern Med 1989;149:2509-11.
2.9. How should you adjust her warfarin dose?
1980 American Family Physician
Volume 71, Number 10
◆ May 15, 2005
Outpatient Anticoagulation Flowsheet
Patient’s name: Date of birth: / / Medical record #:
Indication for anticoagulation (check one): ❏ Atrial fibril ation
Target International Normalized Ratio (INR)*: ❏ 2.0 to 3.0 ❏ 2.5 to 3.5 ❏ Other:
Start date: / / Therapy duration: ❏ 3 months ❏ 6 months ❏ 1 year ❏ Indefinite ❏ Other:
Dosage Adjustment Algorithms
For target INR of 2.0 to 3.0, no bleeding*:
Increase dose 10 to 20%; Increase dose No change
For target INR of 2.5 to 3.5, no bleeding*:
Increase dose 10 to 20%; Increase dose No change
*—See reverse side for further guidance.
†—If INR is 1.8 to 1.9 or 3.1 to 3.2, consider no change with repeat INR in seven to 14 days.
‡—For example, if a patient has had three consecutive in-range INR values, recheck in 3 weeks.
§—If INR is 2.3 to 2.4 or 3.6 to 3.7, consider no change with repeat INR in seven to 14 days.
Outpatient Anticoagulation Flowsheet (continued)
Anticoagulation Decision Support
DVT or PE1
then warfarin (Coumadin); treat until cancer is resolved*
First episode, antiphospholipid antibodies or at least two risk factors†
Rheumatic mitral valve and atrial fibril ation or previous emboli
Rheumatic mitral valve disease, normal sinus rhythm, and left atrial
Mitral tilting disk valves and bileaflet mechanical valves
Aortic CarboMedics bileaflet or Medtronic Hall tilting disk valves,
Mechanical valves with risk factors (atrial fibril ation, myocardial
infarction, LAE, endocardial damage, low ejection fraction)
Mechanical valve with breakthrough embolism despite INR 2.0 to 3.0
Management of Significantly Elevated INR With or Without Bleeding4
INR 5.0 to 8.9, no significant bleeding: Omit 1 to 2 doses; reduce dose 10 to 20 percent; monitor frequently. Alternatively
consider vitamin K1 1.0 to 2.5 mg oral y.
INR ≥ 9.0, no significant bleeding: Hold warfarin therapy; give vitamin K1 5.0 to 10 mg oral y; monitor frequently. Resume at
Serious bleeding, any INR: Hold warfarin; give vitamin K1 10 mg slow IV plus fresh plasma or prothrombin complex concentrate,
depending on urgency; repeat vitamin K1 every 12 hours as needed.
Life-threatening bleeding, any INR: Hold warfarin; give prothrombin complex concentrate (or recombinant factor VIIa as an
alternative) supplemented with vitamin K1 (10 mg slow IV); repeat as needed.
INR = International Normalized Ratio; SORT = Strength-of-Recommendation Taxonomy; DVT = deep venous thrombosis; PE = pulmonary embolism; LMWH = low-molecular-weight heparin; LAE = left atrial enlargement; IV = intravenous.
A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, opinion, or case series.
*—Consider indefinite therapy for selected patients.
†—Deficiency of antithrombin III, protein C, or protein S; prothrombotic gene mutation such as V Leiden or prothrombin 20210; homocystinemia, or factor VIII levels above the 90th percentile of normal; or persistent residual thrombosis on repeated testing with compression ultrasonography.
‡—Not indicated in patients younger than 65 years who do not have risk factors (i.e., heart failure, hypertension, previous ischemic stroke or transient ischemic attack, or diabetes mel itus).
1. Bul er HR, Agnel i G, Hull RD, Hyers TM, Prins MH, Raskob GE. Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP
Conference on Antithrombotic and Thrombolytic Therapy [published correction appears in Chest 2005;127:416]. Chest 2004;126(3 suppl):401S-428S.
2. Singer DE, Albers GW, Dalen JE, Go AS, Halperin JL, Manning WJ. Antithrombotic therapy in atrial fibril ation: the Seventh ACCP Conference on Antithrombotic and
Thrombolytic Therapy. Chest 2004;126(3 suppl):429S-456S.
3. Salem DN, Stein PD, Al-Ahmad A, Bussey HI, Horstkotte D, Mil er N, et al. Antithrombotic therapy in valvular heart disease – native and prosthetic: the Seventh ACCP
Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004;126(3 suppl):457S-482S.
4. Ansell J, Hirsh J, Poller L, Bussey H, Jacobson A, Hylek E. The pharmacology and management of the vitamin K antagonists: the Seventh ACCP Conference
on Antithrombotic and Thrombolytic Therapy [published correction appears in Chest 2005;127:415-6]. Chest 2004;126(3 suppl):204S-233S.
The Most Current and Complete Summary of Alabama Jury Verdicts June, 2013 Statewide Jury Verdict Coverage - Published Monthly 13 A.J.V.R. 6 Alabama’s Jury Verdict Reporter Since 2001 * * *The Book is Back with its 11th Edition * * * Jefferson County Auto Negligence - Defense verdict p. 2 Auto Negligence - Defense verdict p. 4 Insurance Agent Neg. - $40,000This important volume
www.protectpeachcove.com Po Box 3014 Onerahi 3/11/03 Paul Batten NZ Recreational Fishing Council Dear Paul, We are pleased that the NZRC is looking at the possible impacts of aquaculture in Northland on recreational fishing. We have found ourselves wearing two hats as we go through the process with the Peach Cove Appeal as many of the issues will be pertinent to the potential or otherwise of