Induction Protocols

​

Any patients that do not need urgent anticoagulation may be referred to the anticoagulant department for warfarin induction as an out patient.

 

Inpatient Induction - (Anticoagulant team provide dosing)

   Follow the protocol outlined on page 2 of the warfarin referral form

• Fill out section one (page 3) and patient details (page 4) of the pink chart and send the chart with an INR (citrate sample) to the haematology laboratory

• Ensure that the risk assessment on the form is signed to say it has been completed

• Give the patient the 'patient leaflet - starting warfarin therapy'

• The pink chart will be returned to the ward with a recommended dose and next test date. - follow the instructions

• Once the patient is therapeutic the anticoagulant clinic will recommend that the ward doctors continue dosing using the yellow continuation sheet until discharge.

 

NB:  If a patient has been started on the Fennerty induction regime then the patient must stay the responsibility of the ward until a maintenance dose has been established and the patient has received the minimum 5 days recommended Low Molecular Weight Heparin (LMWH) and has had two INR results above 2.0 on two consecutive occasions.  The anticoagulant service cannot provide daily appointments and cannot administer LMWH injections.

 

Inpatient continuation dosing (ward doctors to provide dosing)

It is the ward doctors responsibility to dose any patients admitted to the ward already taking warfarin, and for patients that have been initiated on warfarin and are now out of the induction phase but are still an inpatient; use the yellow warfarin continuation chart to record the INR and warfarin dosage.

​

Outpatient Induction (Anticoagulant team initiating warfarin)

   Follow the protocol outlined on page 2 of the warfarin referral form

• Complete section one (page 3) and section three (page 4) of the pink chart

• Send/fax the referral to the anticoagulant department at PGH (fax 57099)

• Telephone the clinic to inform them of the patient

• Ensure that if the patient requires hospital transport that the anticoagulant clinic is aware.

​

​

Fennerty Induction Protocol

​

Fennerty induction is a rapid induction protocol and is used for patients that have suffered from thrombosis or require rapid anticoagulation for other risk factors.

 

Fennerty induction must only be used when concurrent low molecular weight heparin (LMWH) is administered until the warfarin levels become therapeutic.  LMWH must be continued for a minimum of 5 days and until the INR is greater than 2.0 for 2 consecutive days.

 

Fennerty induction dosing requires a baseline INR on day 1 and further daily INRs to day 4.  If a patient is being commenced on Fennerty induction it is the ward's responsibility to arrange for the patient to have their LMWH administered daily and daily INR tests. The patient will only become the responsibility of the anticoagulant clinic once that patient has been counselled in the outpatient setting.

​

Glasgow (Tait) Induction Protocol

​

The Glasgow or Tait induction protocol is a slower or gentler approach to warfarin initiation. It is generally used for patients that have cardiac problems such as AF but can be also used in elderly patients or patients with complex medical history or other risk factors.

​

Glasgow induction dosing requires baseline INR on day 1 then further INR tests on day 5 and day 8.  If a ward doctor is initiating the therapy please take into account the service provisions for when day 5 and day 8 will fall.

​

​