Anticoagulation Services

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• Venous Thromboembolism (Diagnosis, Prevention Treatment)
• Optimum Therapeutic Ranges and Duration of Anticoagulation (pdf)
• Warfarin
• Guidelines for Correction of Warfarin Over-Anticoagulation
• Guidelines for Dosing and Monitoring of Low-Molecular Weight Heparin (LMWH)
• Peri-Procedural Anticoagulation
• Neuroaxial Anesthesia in the Anticoagulated Patient
• Heparin Protocols for UWMC
• Heparin-Induced Thrombocytopenia
• Central Venous Catheter Management
• Alternative Monitoring for Antithrombotic Agents at UWMC
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Risk Stratification for Determining Need for Bridge Therapy

Risk Stratum	Indication for Warfarin Therapy
	Mechanical Heart Valve	Atrial Fibrillation	Venous Thromboembolism
High	any mitral valve prosthesis older (caged-ball or tilting disc) aortic valve prosthesis recent (within 6 months) stroke or transient ischemic attack	CHADS2 score of 5 or 6 recent (within 3 months) stroke or transient ischemic attack rheumatic valvular heart disease	recent (within 3 months) VTE severe thrombophilia (e.g., deficiency of protein C, protein S or antithrombin, antiphospholipid antibodies, or multiple abnormalities)
Moderate	bileaflet aortic valve prosthesis and one of the following: atrial fibrillation, prior stroke or transient ischemic attack, hypertension, diabetes, congestive heart failure, age >75 years	CHADS2 score of 3 or 4	VTE within the past 3 to 12 months (consider VTE prophylaxis rather than full intensity bridge therapy) non-severe thrombophilic conditions (e.g., heterozygous factor V Leiden mutation, heterozygous factor II mutation) recurrent VTE active cancer (treated within 6 months or palliative)
Low	bileaflet aortic valve prosthesis without atrial fibrillation and no other risk factors for stroke	CHADS2 score of 0 to 2 (no prior stroke or transient ischemic attack)	single VTE occurred greater than 12 months ago and no other risk factors

 

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