Anticoag Rx
Offline · FDA PI / CHEST / ACC-AHA
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Starting anticoagulation
Initiating warfarin or a DOAC for a new diagnosis.
Warfarin initiation nomogram
DOAC selection & first dose
Renal-adjusted starting dose
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Adjusting & monitoring
Patient is already on therapy — titrate or recheck.
INR-based warfarin titration
DOAC renal re-check
Drug interaction review
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Stopping for a procedure
Periprocedural interruption, bridging, or restart.
UFH / enoxaparin bridge dosing
Valve / VTE risk stratification
Restart timing after procedure
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Active bleeding / reversal
Life-threatening bleeding or emergent pre-procedure reversal.
4F-PCC and idarucizumab
Indications, dosing, contraindications
Institution-variable — verify locally
Or jump straight to a drug
Warfarin
Apixaban
Rivaroxaban
Dabigatran
Edoxaban
Unfractionated Heparin
Enoxaparin
References
  1. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron. 1976;16(1):31-41. (CrCl equation used for DOAC/UFH dosing)
  2. Devine BJ. Gentamicin therapy. Drug Intell Clin Pharm. 1974;8:650-655. (Ideal body weight formula)
  3. Lip GYH, Nieuwlaat R, Pisters R, Lane DA, Crijns HJGM. Refining Clinical Risk Stratification for Predicting Stroke and Thromboembolism in Atrial Fibrillation Using a Novel Risk Factor-Based Approach. Chest. 2010;137(2):263-272. (CHA₂DS₂-VASc score and annual stroke-risk-by-score table)
  4. Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJGM, Lip GYH. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation. Chest. 2010;138(5):1093-1100. (HAS-BLED bleeding risk score)
  5. Lo GK, Juhl D, Warkentin TE, Sigouin CS, Eichler P, Greinacher A. Evaluation of pretest clinical score (4 T's) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings. J Thromb Haemost. 2006;4(4):759-765. (4Ts HIT pretest probability score)
  6. Cuker A, Arepally GM, Chong BH, et al. American Society of Hematology 2018 guidelines for management of venous thromboembolism: heparin-induced thrombocytopenia. Blood Adv. 2018;2(22):3360-3392. (HIT management)
  7. Raschke RA, Reilly BM, Guidry JR, Fontana JR, Srinivas S. The weight-based heparin dosing nomogram compared with a "standard care" nomogram: a randomized controlled trial. Ann Intern Med. 1993;119(9):874-881. (UFH weight-based nomogram)
  8. Douketis JD, Spyropoulos AC, Duncan J, et al. Perioperative Management of Patients With Atrial Fibrillation Receiving a Direct Oral Anticoagulant. JAMA Intern Med. 2019;179(11):1469-1478. (PAUSE trial — DOAC perioperative interruption timing)
  9. Douketis JD, Spyropoulos AC, Murad MH, et al. Perioperative Management of Antithrombotic Therapy: An American College of Chest Physicians Clinical Practice Guideline. Chest. 2022;162(5):e207-e243. (2022 CHEST Perioperative Antithrombotic Therapy Guideline)
  10. Witt DM, Nieuwlaat R, Clark NP, et al. American Society of Hematology 2018 Guidelines for Management of Venous Thromboembolism: Optimal Management of Anticoagulation Therapy. Blood Adv. 2018;2(22):3257-3291. (VKA/CHEST evidence-based anticoagulant management, INR reversal pathways)
  11. Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation. Circulation. 2024;149(1):e1-e156. (Anticoagulation threshold, periprocedural bridging)
  12. Individual direct oral anticoagulant and low-molecular-weight heparin dosing is sourced to each agent's current FDA-approved prescribing information (cited per-drug in the tool) — verify against the live label before clinical use, as this tool's PI-derived data may lag label updates.