1. Ortho Warfarin Dosing Protocol

2. Post-Op Venous Thromboembolism (VTE)
VTE = Deep venous thromboembolism (DVT) and pulmonary embolism (PE)
Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) are associated with the highest risk of DVT
8-70% of pts
Fatal PE in 2-3% of pts without prophylaxis
Can occur days to weeks after discharge

3. VTE Prophylaxis Options in Ortho
Aspirin 325 mg PO BID
Warfarin
New Oral Anticoagulants
Rivaroxaban
Apixaban
Dabigatran
Enoxaparin
Fondaparinux
Low Dose Unfractionated Heparin

4. VTE Ortho
At least 14 days of use
Ideally 4 weeks

5. Warfarin Information Indications: - Treatment and prophylaxis of VTE
Mechanism of Action:
- Vitamin K Antagonist
Dose:
- Patient specific
- Affected by other medications, genetic factors, etc
Laboratory Monitoring:
- PT/INR (Goals vary according to indication)

6. Warfarin Monitoring
Every day the dose of warfarin given the previous day and INR are documented
Alert MD if INR increased > 1, no INR in 72 hours, or INR > 3.5
Document in Direct Charting
Hints: change to 24 hour view, check dose given
Policy in docushare

7. Ortho Warfarin Dosing Protocol
Nomogram to dose patients on warfarin after ortho procedures
Dose is determined by change in INR
Hints:
Post-op Day 0: day of surgery
Does not work if warfarin for any other indication
Policy in Docushare