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Warfarin

Starting treatment
Indications
Dosing and monitoring
Complications
Follow-up
Dosing and monitoring

Give heparin d and LMWH d for a minimum of 5 days and continue for 2 days after the INR is within therapeutic range d  

Why?

  • More patients die who have heparin for five days, and start warfarin on the first day than patients who have heparin for ten days and start warfarin on the fifth day d

Using heparin for 10 days compared with 5 days may reduce mortality

Patient Treatment Comparison Outcome CER RRR
(95% CI)		 NNH
(95% CI)
proximal DVT d heparin for 5 days, and warfarin started on day 1 heparin for 10 days and warfarin started on day 5 death
at 3 months 		32% -30%
(-1800% to 12%) 		16
(8 to 1900)
 

Expiry date: May 2003
Levels of Evidence used in grading these guides

With thanks to Drs. David Keeling, John Reynolds, David Sackett, Sharon Straus and Alan Townsend 
 for use of their anticoagulation guide on which this one is based.

Author   CM   Ball
Reviewer   A   Gallus
CAT Writer   CM   Ball