We’re all familiar with the usual 5mg warfarin initiation protocol (and many of us have distant memories of the 10-10-5 regimes started in hospital, or at least that’s what was being done when I was a junior doctor, back in the
Dark Ages second half of the ’90s). I had, however, heard that it’s possible to initiate warfarin even more slowly, and that has obvious benefits in elderly people being started on it for AF, who don’t need the anticoagulation urgently and are at more risk if they’re overanticoagulated. So, when I had a patient fitting that description, I went looking for a protocol.
I found what I was looking for on the site GP Notebook, which directed me to two studies, of which this one looked like the best bet. The protocol here is to start patients on a 3 mg loading dose daily, and check on Day 8 and Day 15. I’ll try the 3 mg and checking on Day 8, and take it from there.