Warfarin Dosing Calculator

Determines the maintenance dose based on target INR, body surface area and bleeding risk factors.

The warfarin dosing calculator estimates the warfarin maintenance dose based on patient data (weight and height for body surface area), target INR for control over coagulation and based on other bleeding risk factors such as (DVT or PE present or smoking).

Warfarin dose in mg = exp [0.613 + (0.425 x BSA in m2) - (0.0075 x Age) + (0.156 x African-American race) + (0.216 x Target INR) - (0.257 x Amiodarone) + (0.108 x Smoker) + (0.0784 x DVT/PE)]

Where:

BSA in m2 = (Weight in kg)0.425 x (Height in cm)0.725 x 0.007184

Age
Race
Weight & height unit system
Weight
Height
Target INR
Amiodarone in progress
Smoker
DVT or PE present
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Steps on how to print your input & results:

2. Then you can click on the Print button to open a PDF in a separate window with the inputs and results. You can further save the PDF or print it.

Please note that once you have closed the PDF you need to click on the Calculate button before you try opening it again, otherwise the input and/or results may not appear in the pdf.

Variables and formula

The warfarin maintenance dose is most commonly calculated based on patient body surface area and INR results.

There are some risk factors that could be accounted for in the calculation, which is exactly what this calculator does.

The age of the patient is weighted as bleeding risk factor, along with smoking status and possible history or current diagnosis of deep venous thrombosis (DVT) or pulmonary embolism (PE).

It is also checked whether the patient undergoes therapy with Amiodarone (usually for a heart rhythm dysfunction) as there is a strong interaction between that and Warfarin.

The formula used is:

Warfarin dose in mg = exp [0.613 + (0.425 x BSA) - (0.0075 x Age) + (0.156 x African-American race) + (0.216 x Target INR) - (0.257 x Amiodarone) + (0.108 x Smoker) + (0.0784 x DVT/PE)]

Where:

DuBois BSA formula (m2) = (Weight in kg)0.425 x (Height in cm)0.725 x 0.007184

Warfarin dosing

Anticoagulation therapy with Warfarin carries associated bleeding risk that can be exacerbated by the presence of other individual haemorrhage risk factors, therefore thorough assessment is required before initiation and during the treatment.

Warfarin has vitamin K antagonist properties which means it affects the synthesis of active factors II, VII, IX, X and protein C, which are all involved in clotting processes.

Initial doses may vary between 2.5 and 10 mg (depending on the number and importance of bleeding risk factors).

Patients with no risk factors are usually started on a 10 mg/per day dosage for 2 days and treated as outpatients. After the 2 days, INR is measured and a new dosage is established.

Patients with multiple risk factors are started on an initial dose of 2.5 – 3 mg.

The warfarin dose should be titrated against measured INR when used in treating established thromboembolism.

In case an accidental overdose occurs, vitamin K is administered to rapidly correct INR or infusion of fresh frozen plasma is used to further correct the coagulation disorder.

Bleeding risk factors

Patients older than 65 with chronic heart failure or other comorbidities are at a higher risk of haemorrhage.

Risk assessment is used for patients who undergo surgery or need anticoagulant medication. Some common bleeding risk factors include:

■ Bleeding history, anemia or predisposition;

■ Previous history of stroke;

■ Labile INR;

■ Drug therapy, especially with NSAIDs;

■ Hypertension (with SBP more than 160 mmHg);

■ Abnormal liver function, cirrhosis or significant impairment usually with AST/ALT/ALP more than 3 times higher;

■ Abnormal renal function (chronic dialysis or serum creatinine more than 2.3 mg/dL);

■ Malignancy.

Therapy recommendations based on INR

The function of the factors II, V, VII and X in the coagulation pathway can be evaluated through the International Normalized Ratio and the prothrombin time (PT).

There are different dosing recommendations depending on the INR value which is regularly determined for patients who undergo anticoagulation therapy with Warfarin or other substances.

 INR value Indication Dose increase / re-dosage time <1.5 If non-compliant: resume therapy at previous dose; (OR) Increase maintenance dose by 5%- 20%. 1.5 – 1.9 If non-compliant: resume therapy at previous dose; (OR) Increase maintenance dose by 5 - 15%; Re-dosage after 3 – 7 days. 2.0 – 3.0 Maintain current dose; Re-dosage after 1 month. 3.1 – 3.4 Maintain dosage but re-check after 3 – 7 days; Consider decreasing dose by 5 - 10% and/or holding one dose. 3.5 – 3.9 - Consider holding one dose; Re-dosage after 1 – 3 days. 4.0 – 4.9 Hold warfarin until INR reaches therapeutic range; Consider lowering maintenance dose by 5%- 20%; Monitor daily. >5.0 Hold warfarin until INR reaches therapeutic range; Monitor daily.

References

1. Gage BF, Eby C et al. Use of pharmacogenetic and clinical factors to predict the therapeutic dose of warfarin. Clin Pharmacol Ther. 2008; 84(3):326-31.

2. Holbrook A, Schulman S, Witt DM, Vandvik PO, Fish J, Kovacs MJ, Svensson PJ, Veenstra DL, Crowther M, Guyatt GH; American College of Chest Physicians. Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141(2 Suppl):e152S-84S.

3. Baglin TP et al. British Committee for Standards in Haematology - Guidelines on oral anticoagulation (warfarin): third edition - 2005 update. British Journal of Haematology 2006; 132 (3): 277-285.

4. Bennett ST, Critchfield GC. Examination of International Normalised Ratio (INR) imprecision by comparison of exact and approximate formulas. Intermountain Laboratory Data Project. J Clin Pathol.1994; 47(7): 635–638.

5. Du Bois D, Du Bois EF. A formula to estimate the approximate surface area if height and weight be known 1916. Nutrition. 1989; 5(5):303-11; discussion 312-3.

Specialty: Pharmacology

Objective: Determination

Type: Calculator

No. Of Variables: 8

Article By: Denise Nedea

Published On: June 14, 2017 · 11:26 AM

Last Checked: June 14, 2017

Next Review: June 14, 2023