WarfarinGuide vs MAPPP

Warfarin Guide offers three resources essential for systematic and careful evidence-based anticoagulation with Warfarin. First it reviews recommendations on indications, INR targets, and treatment duration from the American College of Chest Physicians 8th Edition guidelines on Antithrombotic and Thrombolytic Therapy from 2008, updated for the 2012 guideline. Second it offers a protocol for Warfarin dose adjustment depending upon INR result. And third is a discussion of protocols for the initiation of Warfarin. These resources come from point of care guides on these topics in the family medicine literature as well as the 2012 ACCP guideline. The app also offers guidance for management of peri-operative Warfarin by directing the user to oexcellent comprehensive resources for managing all anticoagulants and antiplatelet agents around surgery. The app addresses such common questions as: •which artificial heart valves require that higher level of anticoagulation? •how do I respond to an INR of 7.4? •this pt needs Warfarin, how do I get it started? •I'm adjusting the total weekly warfarin dose down by 5%, when should I recheck the INR? •when do I give Vitamin K to reverse Warfarin anticoagulation and at what dose?? This app is written and intended for practicing clinicians involved in Warfarin anticoagulation such as internists, cardiologists, family physicians, nurses, pharmacists, PA's and NP's; for resident physician trainees; and for medical students. As an educator and clinician, I am interested in feedback and I would be grateful for guidance on improving the tool.

Despite the considerable efficacy of antithrombotics and the increased number of oral anticoagulants now available, preventable bleeding and thrombotic events are still unacceptably common. While recently marketed agents require less laboratory monitoring, problems with the clinical management of anticoagulated patients persist, particularly in the peri-procedural period. Surgery and invasive medical interventions increase the risk of bleeding, while withholding anticoagulants increases the risk of thrombosis due to the underlying condition(s) for which anticoagulation was originally prescribed. The clinical team must therefore balance these competing risks and make educated decisions regarding the decision to interrupt oral anticoagulation for a medical procedure and, if interrupted, whether to "bridge" anticoagulation with injectable anticoagulants, such as low molecular weight heparin (LMWH) in warfarin treated patients. This guide is intended to: -Assist clinicians in the simultaneous evaluation of procedure-related bleeding risk and underlying risk of thrombosis -Guide decisions regarding the interruption of anticoagulation and the use of anticoagulant "bridging" -Provide detailed guidance for drug dosing and laboratory monitoring in the peri-procedural period -Encourage clear communication between clinicians involved in prescribing anticoagulants and performing invasive procedures This material was created by the multidisciplinary members of the Peri-Procedural Task Force of the New York State Anticoagulation Coalition and IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy. 10SOW-NY-AIM-7.3-14-01