Any suggestions for using the RAT programme when patients are going for surgery?
We are starting to help with the bridging of warfarin for patients who are having surgery. Most will stop their Warfarin 5 days before their surgery and may be treated with Clexane. They will restart their usual dose of Warfarin on the evening after their surgery and will have their INR done 4 days later by their GP, if they have been discharged. Is it best to enter in the 0mg doses for the days that patients are off their Warfarin and the doses they take post op or just to go on the RAT recommendations on Day 4 as if they had never been off their Warfarin?

Dear Roy,
Best not to put in 0mg.
You will know from the patient's previous weekly dose regimen what dose will get them back to a therapeutic INR.

The dilemma is how quickly to get them back into range.
If they go back on their usual dose it will take about 10 days. So just enter in the scribble pad a note to that effect and do not increase the warfarin dose within the 10 days.
For AF this is not a big issue.

The more important patients are the ones who have clotted e.g. DVT / PE
So with these patients you may want to give them a loading dose of 10 or 8 mg to speed up the process. For these patients they need to be covered with enoxaparin until you get them back into range. So a loading dose ( not essential) will reduce the number of days on enoxaparin.

Colm Rafferty