Online Coumadin Dosing Calculator

[Ross]

http://www.pace-med-apps.com/CoumCalc.htm

 

[Faye]

Thanks for sharing. I tried it out and was pleased that the on-line calculator matched what my pump head brain (trained by Al's chart) would do.

 

[Eva]

This is neat...my husband was trying to creat such a system for me using Al's chart as a guide. But of course, he did not have the time yet. Will show him this. Thanks for sharing, Ross.

Question: What day should I put at the top? Day 1 or day 6?

 

[Ross]

Don't use both parts. Either your just starting or your continuing. All you need fill in is either the total weekly amount your taking or the daily amount your taking and check the appropriate box and set what your current INR is and calculate.

 

[westie]

doubts

doubts

.
hi ross

in the past, you have expressed concerns about the accuracy of online inr calculators.

is this a proven system that you have got faith in?

 

[Roger Frank]

Sweet!

Thanks!

 

[Bina]

.
hi ross

in the past, you have expressed concerns about the accuracy of online inr calculators.

is this a proven system that you have got faith in?

Westie, I believe you are referring to the software programs that we have discussed in the past and had concerns about.
This one is more of a fancy calculator. It's perfect.

 

[Ross]

.
hi ross

in the past, you have expressed concerns about the accuracy of online inr calculators.

is this a proven system that you have got faith in?

Software programs I don't trust until they've proven correct. This calculator comes up with the same answers I would on my own calculator.

 

[Karlynn]

This calculator just take the guidelines (such as I've always used from this site http://www.aafp.org/afp/990201ap/635.html) and uses it as the basis for it's calculations. I've found it helpful. Not as much brain work.

 

[bigsidster]

can anyone lead me to ALS CHARTS

 

[Bina]

can anyone lead me to ALS CHARTS

Al Lodwick has recently retired and so has his Warfarinfo web site.

 

[pellicle]

I found this today:

http://www.pharmgkb.org/download.action?filename=IWPC_dose_calculator_6-19-09.xls

seems very close to my dose. Given I don't know my factors for VKORC1 or CYP2C9 genotype I tried a few options and found my does in the middle of the various ranges generated by the various settings for these.

 

[almost_hectic]

All these links seem out of date and only redirect to suspicious sites

 

[tom in MO]

almost_heritic is correct. Anyone have a working link to a warfarin dosing calculator?

 

[pellicle]

almost_heritic is correct. Anyone have a working link to a warfarin dosing calculator?

Quite the zombie thread, my last was 2013 above almost_hectic. Even then what I had seen in my readings was that they were useless without genetic markers (which I mentioned) and were used infrequently in clinical situation because empirical evidence-based measurement gave results as good or better (even with the genetic data) A PhD thesis I read from back in the 2000's suggest that European clinics use stochastic tools based on client historical data.

So I would question how accurate such free online tools mab be.

Did you have a specific question Tom?

 

[tom in MO]

Quite the zombie thread, my last was 2013 above almost_hectic. Even then what I had seen in my readings was that they were useless without genetic markers (which I mentioned) and were used infrequently in clinical situation because empirical evidence-based measurement gave results as good or better (even with the genetic data) A PhD thesis I read from back in the 2000's suggest that European clinics use stochastic tools based on client historical data.

So I would question how accurate such free online tools mab be.

Did you have a specific question Tom?

Thanks Pellicle.

In the US, insurance companies have allowed cardiologists to start charging for reviewing home monitoring and testing results. What was once free, costs $30 (before insurance discount) or 24 testsx30=$720/year more profit for the cardiologist. I test at home and no longer wish to call in every result and be charged. My cardiologist said I can call in when out of range but at least every month.

So I'd like to test more often than once a month and do my own adjustments in the interim. In the past when an adjustment was needed, my personal guess for my new dose or adjustment was pretty much on target. When I call it in, the nurse takes a few hours to respond when you are out of range. I assume (maybe incorrectly) that he/she goes to some computer program or set of decision rules which tells them what the adjustment should be. This is then "approved" by the doctor and that's the charge I see.

 

[pellicle]

Hi

So I'd like to test more often than once a month and do my own adjustments in the interim. In the past when an adjustment was needed, my personal guess for my new dose or adjustment was pretty much on target.

well actually that's probably pretty good anyway as you already have a lot of experience in this. To my observation most of the guidelines are centered around the idea of "starting" because once started warfarin dosage is totally guided by intention to keep within an INR range, thus the dosage is simple.

When I call it in, the nurse takes a few hours to respond when you are out of range. I assume (maybe incorrectly) that he/she goes to some computer program or set of decision rules which tells them what the adjustment should be. This is then "approved" by the doctor and that's the charge I see.

You are correct that there will be software, indeed a google search shows many options on the market (I could paste in a few that I've found however they're clearly aimed at clinics. Back when I was researching things more actively (2012 ~2014) I found a number of good papers which formed the basis for my approach. One was a 2009 paper (submitted as thesis research for a PhD) which undertook an analysis of 2 such softwares, She compared ICAD and TRODIS which was ultimately passed by an experienced clinician to make the final determination (probably because its easier to hold a person responsible than a machine). I expect that AI systems may indeed emerge soon (perhaps).

I can send you that paper if you want, but my take on it was that (and it did such analysis) without properly taking into account the VKORC1 and CYP2C9 genetic types (requires a blood test and genetic typing) that the results of algorithms were less than perfect.

This site still seems to work:
www.globalrph.com/warfarin_calc.htm

however if you read it you'll see that its really mainly oriented for starting patients. Us long termers need to have gathered our own data.

If you need any help on this please feel free to email me and I can share a spreadsheet (google sheet) which I can talk your through and which will make things easier (assuming you don't already have something like that now).

Best Wishes

 

[tom in MO]

Thanks a lot Pellicle. I think I'll do it by the seat of the pants right now. Keep It Super Simple (KISS) or Keep It Simple Stupid until I screw it up

Kind of interesting that there isn't an "App" for it, if only to allow a patient to verify what the nurse/doctor said their new dose would be. But then that would threaten the jobs of medical personnel and probably excite the lawyers (in the US.) What's even more telling, is the fact that there is software available for first time warfarin users,who wouldn't be looking to do it themselves yet anyway.