TABLE 3.
Examples of warfarin dose initiation and dose adjustment guidelines for venous thromboembolism by SSA countries' departments or ministries of health
| Guideline | Warfarin dose initiation guideline | Warfarin dose adjustment guideline |
|---|---|---|
| Ghana Standard Treatment Guidelines 201097 | “Warfarin, oral, adults: 10 mg daily at 6 pm for 2 days, then 5 mg daily” | “Regular dose adjustment and monitoring of INR until target of 2.0 and 3.0 is attained” |
| Namibia Standard Treatment Guidelines 201198 | “Warfarin: 5 to 10 mg orally; start at same time as heparin” | “Adjust dose according to INR” |
| Ethiopia Standard Treatment Guidelines for General Hospitals 201499 | “Warfarin (starting simultaneously with heparin), 5 mg orally, daily” | “Dose adjusted to achieve target INR of 2.0 to 3.0″ |
| Uganda Clinical Guidelines. National Guidelines for Management of Common Conditions 2016100 | “… plus warfarin 5 mg single dose given in the evening, commencing on the same day as heparin” | “Maintenance dose 2.5 to 7.5 mg single dose daily, adjusted according to the INR 2 to 3″ |
| Kenya National Guidelines for Cardiovascular Diseases Management 2018101 | “Recommended starting dose: 5 mg orally once a day” | “Typical maintenance dose: 2 to 10 mg orally once a day. Dosage must be individualized according to the patient's INR” |
| Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019102 |
Day 1: 5 mg daily (2.5 mg daily for high sensitivity) 2‐3 d after initiation: • 5‐7.5 mg/d if INR < 1.5 • 2.5‐5 mg/d if INR 1.5 to 1.9 • 2.5 mg/d if INR 2.0 to 2.5 • hold warfarin if INR > 2.5 2‐3 d after last INR check: • 7.5‐10 mg/d if INR < 1.5 • 5‐10 mg/d if INR 1.5 to 1.9 • 2.5‐5 mg/d if INR 2.0 to 3.0 • hold warfarin if INR > 3 |
• Increase weekly dose by 10% if INR < 1.5 • Increase weekly dose by 5% if INR 1.5 to 1.9 • No change to warfarin dose if INR 2.0 to 3.0 • Decrease weekly dose by 5% if INR 3.1 to 4.0 • Decrease weekly dose by 10% if INR 4.1 to 5.0 • Decrease weekly dose by 20% if INR 5.1 to 9.0 |
INR, international normalised ratio.