Hi Stephanie,
Sorry for the late reply … we’ve been dosing warfarin / doing anticoagulation consults since 2010. We not only dose the warfarin, we also manage the intradialytic heparin / LMWH, bridging certain warfarin patients when needed, etc.
I know the BC group has an RN driven algorithm … but I believe it just causes more unnecessary bloodwork that needs to be drawn. If the pharmacist tracks it and asks the appropriate questions / patient history, managing warfarin / anticoagulation isn’t that much work … I personally find it satisfying.
For a population of 260 renal patients (inpatients + outpatients), we have 34 patients on warfarin that we manage. We order INRs weekly (MON or TUES) … and rarely do we order extra INRs (ie new start dialysis, started cotrimoxazole, etc). We do have a suggested dosing algorithm for the evening patients if we don’t get the lab results back before we finish rounds … it’s easy … unless they’re bleeding or have an INR that is 0.5 above the accepted target range, continue on their regular dose that night and we’ll call the patient the following day. Otherwise, hold that night’s dose (ie bleed / supratherapeutic INR). We can order Vitamin K without the MD, but that’s a really rare instance.
Perhaps you can trial it with one HD group and compare with how your current practice is.
– derrick
