ORIGINAL ARTICLESPractical application of the 10-mg warfarin initiation nomogramWells, Philip Sa,b; Le Gal, Grégoirea,c; Tierney, Saraha; Carrier, MarcaAuthor Information aThrombosis Program, Division of Hematology, Department of Medicine, University of Ottawa, Canada bClinical Epidemiology Program, The Ottawa Health Research Institute, Ottawa, Ontario, Canada cEA3878, Department of Internal Medicine and Chest Diseases, Brest University Hospital, Brest, France Received 17 October, 2008 Revised 5 January, 2009 Accepted 24 January, 2009 Correspondence to Dr Philip S. Wells, Suite F6-49, 1053 Carling Avenue, The Ottawa Hospital, Civic Campus, Ottawa, ON K1Y 4E9, Canada Tel: +1 613 798 5555 x18769; fax: +1 613 761 5351; e-mail: email@example.com Blood Coagulation & Fibrinolysis: September 2009 - Volume 20 - Issue 6 - p 403-408 doi: 10.1097/MBC.0b013e32832b184d Buy Metrics Abstract Initiation of warfarin therapy is a clinical challenge. A 10-mg warfarin initiation nomogram was recently validated in a randomized controlled trial. We sought to determine the efficacy and safety of this 10-mg warfarin initiation nomogram in ‘real-life’ daily practice. A retrospective cohort including all outpatients beginning concurrent treatment with warfarin and low-molecular-weight heparin over a 24-month period in our Thrombosis Unit was reviewed. Eight hundred and forty-one patients were included; of them, 640 (76.1%) were started on the nomogram. The nomogram was entirely followed in 324 patients (38.5%). The efficacy and safety profile was similar to that observed in the original clinical trial; 86% of patients managed according to the nomogram reached the international normalized ratio target of 2.0–3.0 within 5 days. Mean duration of low-molecular-weight heparin treatment was 6.0 ± 1.9 days, and 3.7% of patients had an international normalized ratio of at least 5.0 in the first 4 weeks of treatment. The 10-mg nomogram effectively results in an early therapeutic international normalized ratio with a good safety profile in ‘real-life’ daily practice. © 2009 Lippincott Williams & Wilkins, Inc.