It is apparent that there is an expectation that bleeding risk (baseline status) be established before any patient is placed on an anti-coagulant. NPSG 03.05.01 EP 3 more or less states that a baseline status must determined. We are fortunate if we are dealing with warfarin (INR) or Heparin (aPTT) but I have seen no really good examples of how to assess this status for other medications, and it is becoming more important because of new products on the market, such as Pradaxa (dabigatran etexilate) that have no laboratory value available to monitor the drug. Lovenox (enoxaparin) can be monitored with an Anti factor Xa, but this test seems to be difficult to obtain.
I have just posted to the web site (www.redandgold.com) anticogulation information from Baptist Health System. On Page 2, there is a section called “Bleeding Risk Factors” that I though would be a good starting point for such an assessment.
If any of the readers have a good way to assess baseline coagulation status, I would love to see it and post it.
Look in the NPSG section and get the file “Warfarin Dosing and Bleeding Risk Assessment.”