Start with loading dose of 10 millegrammes, 10 millegrammes , 5 millegrammes on first three days. Check INR
on day 3. Adjust Warfarin dose according to INR. Only when INR is 
2,
can heparin be discontinued. In anticipation of surgery/ angiogram stop
Warfarin (there is often a reluctance to stop it) and commence on Heparin when
INR falls to 2 or less. Heparin should be stopped preop at 6 am. A repeat coag is
needed the morning of surgery.
On commencing a patient for the first time on Warfarin, a full explanation of the drug is needed as well as its interactions.
A Warfarin information booklet is available on the ward for patients to keep. The intern caring for the patient must repeatedly go through and explain the booklet to the patient. The doctor who prescribes Warfarin for patient is responsible for problems it causes and for arranging schedule for INR checks.
The patient's GP and relatives should be informed re. warfarinisation. Limit the duration of treatment from the outset. Patient admitted to hospital should have their indication for warfarinisation checked.
NOTE - Up to 20% of patients on Warfarin have no indication for it.
On discharge, ensure adequate follow up whether it be with GP or Warfarin clinic.
Care with giving Warfarin to
Immediate reversal by giving FFP, vitamin K gives more prolonged reversal
PATIENTS DIE OF WARFARIN !!
List of Drugs that interact with Warfarin