I noticed that if a high INR is entered, RAT sometimes advises to stop warfarin for 2 days. But when you look at the dosing instructions, it gives dosages for every day, and the weekly total is calculated as if warfarin is taken every day. Does RAT take into account that it has instructed the patient to stop warfarin for 2 days?

Dear Richard,
RAT gives the new dose for each day after the 2 days of no warfarin. You will note it says to 'restart' at new dose.
The logic is that if a patient fails to reattend on the new review date they will have a dosage schedule to continue on.


When an INR is between 4.5-5.5 the new weekly dose is calculated at 75-80% of previous dose to take into account the 2 days of no warfarin.


Colm Rafferty

Hi Colm

I am just wondering if the above still applies? When a patient is instructed to miss 2 days warfarin and return in a week I do not modify RAT. However a colleague does change the total weekly dose to reflect the 2 missed doses.

We were just wondering which is the correct method.

Thank you

Kelly

Dear Kelly
You are correct , do not modify the weekly dose. RAT takes it into account, and adjusts the new dose of warfarin on the basis that the patient has missed 2 doses.
Regards
Colm