华法林的初始治疗

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1、华法林的初始治疗StartingandManagingWarfarin/CoumadinforInitialTreatmentofDVT/PETheACCP'snew9theditionoftheirclinicalpracticeguidelinesforpreventionandtreatmentofDVT/PEwerepublishedinFebruary2012.Herewereviewtheirupdateonhowtostartapatientonwarfarin(Coumadin)fordeepvenousthrombosisorpulmonaryemb

2、olism(DVT/PE).SeealsoourreviewsoftheonmanagementofDVT/PE・Answeredhere:What'sthebestinitialCoumadindose?HowoftenshouldtheINRbechecked,howshouldyouadjusttheCoumadindose,andwhat'sthebestwaytomanagebleedingduetohighINR?InthissectionoftheACCP's9thEditionrecommendations,thereareonlytwostronge

3、vidence・basedrecommendations(bothareGradeIB,meaningastrongrecommendationwithmoderateevidence):■?UseatargetINRof2.5(range2.0一3.0).Thisappliestoallpatients,includingthoseathighrisk(e.g.,antiphospholipidantibodysyndromewithpreviousarterialorvenousthrombus,althoughtheydowngradedthatparticul

4、arrecommendationtoGrade2B).Don'tusepharmacogenetictestingtoguidewarfarindosing;it'snotvalidatedandappropriateforwidespreaduse.Theothersarecategorizedasweakrecommendations,basedonmoderateorweakevidence(Grade2Bor2C);here'sasummary.HowtoStartWarfarinforDVT/PE:??Startpatientsonwarfarin10mgd

5、ailyfor2days,then(ratherthanchoosingthedoseyouthinkthey'llneedattheoutset).Thereisnoneedtotreatwithheparinforseveraldaysbeforestartingwarfarintherapy(thesupposedthreatofwarfarinskinnecrosisisabogeymanthatunnecessarydelaystherapy,theyadvise).Youcansafelystartwarfarinonday1or2ofheparinthe

6、rapy.(Grade2C)Whenconsideringwhethersomeoneisa—candidateIIforwarfarin,don'tdisqualifythemonthebasisofaclinicalpredictionrule'sratingthemashavingahighriskofbleeding—notonthisalone,atleast;usebroaderclinicaljudgment.(Grade2C)HowtoFollow&AdjustWarfarin/CoumadinDoseAccordingtoChangesinI

7、NR:■■?Patientswhoareabletodoitproperlyshouldself-testathome.PeoplewithstableINRscanberecheckedasinfrequentlyasonceevery3months(12weeks).(Grade2B)Whenmakingchangesinwarfarindosing,don'twingit:useavalidateddecisionsupporttoollikeanorforwarfarindoseadjustment.(Grade2C)INRshouldbea