Age-adjusted warfarin initiation protocol

Day INR [NB1] Dose for age (mg) [NB1]

50 years or 51to 65years 66to 80years older than 80
younger years
1 less than 1.4 10 9 7.5 6

2 1.5or less 10 9 7.5 6

1.6or more 0.5 0.5 0.5 0.5

3 1.7or less 10 9 7.5 6

1.8to 2.3 5 4.5 4 3

2.4to 2.7 4 3.5 3 2

2.8to 3.1 3 2.5 2 1

3.2to 3.3 2 2 1.5 1

3.4 1.5 1.5 1 1

3.5 1 1 1 0.5

3.6to 4.0 0.5 0.5 0.5 0.5

more than 4 0 0 0 0

4 1.5or less 10to 15 9to 14 7.5to 11 6to 9

1.6 8 7 6 5

1.7to 1.8 7 6 5 4

1.9 6 5 4.5 3.5

2.0to 2.6 5 4.5 4 3

2.7to 3.0 4 3.5 3 2.5

3.1to 3.5 3.5 3 2.5 2

3.6to 4.0 3 2.5 2 1.5

4.1to 4.5 omit next dose, then use:

1to 2 0.5to 1.5 0.5to 1.5 0.5to 1

more than 4.5 withhold dose

INR = international normalised ratio

NB1: Patients routinely receive warfarin doses at 4.00pm each day during the titration protocol. Blood samples for INR to be obtained between 8.00am and
10.00am (approximately 16hours after the previous dose).
Adapted with permission from Roberts GW, Helboe T, Nielsen CB, Gallus AS, Jensen I, Cosh DG, et al. Assessment of an age-adjusted warfarin initiation
protocol. Ann Pharmacother 2003;37(6):799-803.

Therapeutic Guidelines Limited (www.tg.org.au) is an independent not-for-profit organisation dedicated to deriving guidelines for therapy from the latest world
literature, interpreted and distilled by Australias most eminent and respected experts.

Published in eTG complete, March 2012. Therapeutic Guidelines Ltd. www.tg.org.au