Table. Warfarin Initiation (for patient with average daily dose of 5 mg and target INR >2.0)

    DAY
    INR
    DOSE
    INPATIENT
    (Usually with daily INR)
    		 OUTPATIENT
    1
    		 Normal
    5.0 mg
    ( 2.5 or 7.5-10.0 mg in patients listed in the text )
    		5.0 mg
    ( 2.5 or 7.5-10.0 mg in patients listed in the text )
    2

    < 1.5
    > 1.5
    5.0 mg
    0.0 - 2.5 mg
    		 5.0 mg
    0.0 - 2.5 mg
    . . [If INR is not measured
    5.0 mg]
    3
    < 1.5
    1.5 - 1.9
    2.0 - 3.0
    > 3.0
    5.0 - 10 mg
    2.5 - 5.0 mg
    0.0 - 2.5 mg
    0.0 mg
    		 5.0 - 10 mg
    2.5 - 5.0 mg
    0.0 - 2.5 mg
    0.0 mg

    .

    .

    		 INR should be measured today. If INR is not measured, may use the same dose as day 2, and should not > 5 mg
    4
    <1.5
    1.5 - 1.9
    2.0 - 3.0
    > 3.0
    10.0 mg
    5.0 - 7.5 mg
    0.0 - 5.0 mg
    0.0 mg
    		 10.0 mg
    5.0 - 7.5 mg
    0.0 - 5.0 mg
    0.0 mg
    . . INR measurement should be done, if INR on day 3 is <1.5 or >3.0
    5
    < 1.5
    1.5 - 1.9
    2.0 - 3.0
    > 3.0
    10.0 - mg
    7.5 - 10.0 mg
    0.0 - 5.0 mg
    0.0 mg
    		 10.0 - mg
    7.5 - 10.0 mg
    0.0 - 5.0 mg
    0.0 mg
    . . INR measurement should be done, if INR on day 4 is <1.5 or >3.0
    6
    < 1.5
    1.5 - 1.9
    2.0 - 3.0
    > 3.0
    7.5 - 12.5 mg
    5.0 - 10.0 mg
    0.0 - 7.5 mg
    0.0 mg
    		 7.5 - 12.5 mg
    5.0 - 10.0 mg
    0.0 - 7.5 mg
    0.0 mg
    . . INR measurement should be done, if INR on day 5 is <1.5 or >3.0
    Note: Frequent INR measurement during warfarin initiation helps prevent bleeding from over anticoagulation and helps reaching target INR sooner.