Note: Kindly fill up green colored cell only.

Adjust data in yellow colored ce

HOSPITAL KOTA MARUDU

WARFARIN CALCULATO
MON
5

TUE
4.5

CURRENT WARFARIN DAILY DOSE

WED
THU
4.5
4.5

CURRENT WARFARIN WEEKLY TOTAL

DOSAGE ADJUSTMENT [percentage (+/-)]
NEW WARFARIN WEEKLY TOTAL
WEEKLY WARFARIN ADJUSTMENT

MON

TUE

NEW WARFARIN DAILY DOSE

WED
THUR

Dr. Samson Bd Mokuntil, Hospital Kota Marudu, 2015.

in yellow colored cell if required; DON'T SAVE ANY CHANGES.

A MARUDU

CALCULATOR

FARIN DAILY DOSE

FRI
4.5

SAT
4.5

SUN
4.5

SAT

SUN

32 mg

-10 %
28.80 mg
28.5 mg

RIN DAILY DOSE

FRI

Marudu, 2015.

4.5

WARFARIN DOSAGE AD
INR(1.5-2.5)

INR(2-3)

INR(2.5-3.5)

<1.00

<1.50

<2.00

1.00-1.49

1.50-1.99

2.00-2.49

1.50-2.59

2.00-3.09

2.50-3.59

2.60-3.09

3.10-3.59

3.60-4.09

3.10-3.59

3.60-4.09

4.10-4.59

3.60-4.59

4.10-4.99

4.60-5.59

>4.60

>5.00

>5.60

Follow - up Algorithm
# Consecutive
In - range INRs

Repeat INR in

1
5 - 14 days
2
2-3 weeks
3
4-8 weeks
Updated 02/09/2010EV, MTAC Warfarin Hospital Queen Elizabeth

WARFARIN DOSAGE ADJUSTMENT PROTOCOL

INR(3-4)

DOSAGE ADJUSTMENT

<2.50

Increase weekly dose by 20%. Give

stat dose (double of the new dose)
on the first day do dose increment

2.50-2.99

Increase weekly/daily dose by 10%

3.00-4.09

No change
No change recheck in one week.

4.10-4.59

If persistent, decrease weekly/daily

dose by 5%

4.60-5.09

Omit 1 dose, decrease weekly/daily

dose by 10%

5.10-5.99

Omit 2 dose, decrease weekly/daily

dose by 10%

>6.00

See guideline for treatment of

patients over anticoagulated with
warfarin (refer to doctor)

Reference

1. 1st Edition MTAC Warfarin Protocol, Pharmaceutical Service Division. MOH

2. 2nd Edition MTAC Warfarin Protocol, Pharmaceutical Service Division, MO

n Hospital Queen Elizabeth

REVIEW
Within 2 weeks

2-4weeks
2-3month max

2-4 weeks

1-2 weeks

Within 1 week

Refer Doctor

ce

eutical Service Division. MOH, Malaysia

ceutical Service Division, MOH, Malaysia