WARFARIN FLOW SHEET

Patient: [Name, date of birth]
Weight and kidney function: [Weight, eGFR or creatinine clearance, and the date]
Managed by: [Clinician, pharmacist, or nurse responsible, and the clinic's direct line]
Pharmacy: [Name and phone]

INDICATION AND TARGET
Indication: [Atrial fibrillation, deep vein thrombosis, pulmonary embolism, mechanical valve and its position, or other]
Stroke and bleeding risk: [Scores used, such as CHA2DS2-VASc and HAS-BLED, with the date, or not applicable]
Target INR range: [2.0 to 3.0 for most indications; 2.5 to 3.5 for a mechanical mitral valve, or the range the cardiologist set]
Why warfarin: [Mechanical valve, another reason a DOAC doesn't suit, or the patient's choice after discussion]
Start date: [Date of the first dose]
Planned duration: [3 months, 6 months, indefinite, or lifelong, and the date to review it]
Bridging at the start: [Heparin or enoxaparin, the dose, and the rule for stopping it, or none]
Other drugs that add to bleeding: [Aspirin, other antiplatelets, NSAIDs, SSRIs, or none]

TABLETS AND TESTING
Tablet strength at home: [Strength in mg and its color; one strength only where possible]
How the INR is tested: [Lab draw, clinic fingerstick, or home self-testing, and the meter]
Testing interval: [Every few days at the start, then weekly, then up to every 4 weeks once steady, or as agreed]

INR TABLE
One row per INR, newest last. Doses in mg per week, with the dose for each day.
Date | INR | Weekly dose and daily schedule | Change | Reason or factors | Bleeding or clot symptoms | Next INR | Who was told and how
[Date] | [INR] | [mg per week; mg on each day] | [No change, doses held, or percent up or down] | [Missed or extra doses, new medicine, diet, alcohol, illness, or none found] | [None, or what and what was done] | [Date] | [Patient, caregiver, or prescriber; phone, portal, or in person]
[Date] | [INR] | [mg per week; mg on each day] | [Change] | [Reason or factors] | [Bleeding or clot symptoms] | [Date] | [Who was told and how]
[Date] | [INR] | [mg per week; mg on each day] | [Change] | [Reason or factors] | [Bleeding or clot symptoms] | [Date] | [Who was told and how]
[Date] | [INR] | [mg per week; mg on each day] | [Change] | [Reason or factors] | [Bleeding or clot symptoms] | [Date] | [Who was told and how]

TIME IN THERAPEUTIC RANGE
Method: [Rosendaal linear interpolation, or the share of INRs in range]
Period: [First and last dates counted, leaving out the first weeks of starting warfarin]
TTR: [Percent of days in range over that period]
If below goal: [Causes found, and the plan: adherence aids, more frequent tests, home testing, or whether a DOAC would suit]

INTERACTIONS AND OTHER FACTORS
Interacting medicines now: [Each drug, its expected effect on the INR, and the plan]
Recent starts and stops: [Antibiotics, antifungals, amiodarone, or others, with dates]
Supplements and herbal products: [Each one, or none]
Diet and alcohol: [Usual leafy greens and other vitamin K foods, recent changes, and drinks a week]
Health changes: [Fever, diarrhea, poor appetite, heart failure, liver disease, or a thyroid change]

INTERRUPTIONS AND PROCEDURES
Planned procedures: [Procedure, date, and who performs it]
Hold plan: [Last dose before, bridging if any, and when and at what dose to restart]
Missed doses: [Dates, and what the patient did]

EDUCATION CHECKLIST
Why warfarin, and the target range: [Date taught, and by whom]
Dose calendar and one tablet strength: [Date]
Missed dose: [Take it later the same day; never double up the next day; date taught]
Warning signs: [Bleeding, stroke, and clot signs, and when to call 911 or go to an emergency department; date]
Food and alcohol: [Keep vitamin K intake steady rather than avoid it; alcohol limits; date]
New medicines: [Tell every prescriber, pharmacist, and dentist; ask before any new medicine, supplement, or herbal product; date]
Falls and medical ID: [Fall risk discussed, and a medical alert card or bracelet; date]
Pregnancy: [Contraception and pregnancy plans where relevant, as warfarin can harm a fetus, or not applicable]

REVIEW
Next INR: [Date and place]
Indication review: [Date to confirm warfarin is still needed and still the best choice]
Updated by: [Name, credentials, date]