Management of Outpatient Warfarin Therapy amid COVID-19 Pandemic: A Practical Guide

Abstract

Many healthcare resources have been and continue to be allocated to the management of patients with COVID-19. Therefore, the ongoing care of patients receiving oral anticoagulation with warfarin is likely to be compromised amid this unprecedented crisis. This article discusses a stepwise algorithm for the management of outpatient warfarin therapy. Alternative management strategies are presented and discussed, including alternative pharmacological therapy options and self-monitoring. Our algorithm aims to help clinicians safely optimize the treatment of patients requiring anticoagulation therapy in the context of the global response to the current pandemic.

Fig. 1

A proposed stepwise algorithm for the management of outpatient warfarin therapy. DOAC direct oral anticoagulant, INR international normalized ratio, LMWH low-molecular-weight heparin. ^aConsider appropriateness of indication for warfarin therapy and current bleeding risk. ^bConsider contraindications, indications where DOACs might not be suitable, availability of DOACs in the formulary, and cost issues. ^cOnly for patients with venous thromboembolism. Consider personal preference, renal function, suitability for injection, and cost issues. ^dConsider suitability for self-managed and/or self-monitored INR, a requirement for training prior to self-managed and/or self-monitored INR, local resources, and cost issues