Clinical Decision Support

Warfarin Clinical Decision Agent

compliance

Walks providers through a structured warfarin assessment—bleeding versus thromboembolic risk balance, INR therapeutic-range adherence, drug-food interaction screening, dose-adjustment guidance, and PharmD escalation on hard stops.

Care ManagerPrimary Care PhysicianClinical Documentation
10–15 min
Saved per warfarin monitoring assessment
65%+
Target Time in Therapeutic Range (TTR)
Hard-stop
Catches major interactions (amiodarone, NSAIDs, antibiotics)
Use Case 1

Routine INR Visit Assessment

Trigger: Scheduled anticoagulation clinic visit or INR result review

1.Retrieve current INR, dosing history, missed doses, recent meds, and dietary changes
2.Calculate Time in Therapeutic Range over the last 90 days
3.Apply dose-adjustment nomogram if INR is out of target
4.Screen for new interactions or bleeding signals
5.Reassess HAS-BLED and CHA2DS2-VASc on the standard cadence
6.Recommend dose continuation or adjustment with rationale
7.Generate visit summary with next INR date

Routine anticoagulation visits documented in minutes with TTR-driven dosing decisions.

Use Case 2

Drug Interaction Surveillance

Trigger: New medication added to the patient's medication list

1.Detect the new agent and classify interaction tier (major, moderate, minor)
2.Predict expected INR shift and timing window
3.Recommend monitoring frequency change
4.Generate patient counseling on bleeding signs
5.Escalate major interactions to PharmD with mechanism and proposed monitoring
6.Schedule INR recheck per interaction severity
7.Log the interaction event for trend analysis

Interaction-driven INR shifts caught before they become clinically significant bleeds.

Use Case 3

Periprocedural Anticoagulation Planning

Trigger: Patient scheduled for invasive procedure or surgery

1.Pull procedure type, scheduled date, and bleed-risk classification
2.Calculate CHA2DS2-VASc and HAS-BLED at the periprocedural decision
3.Apply ACCP and AHA bridging guidance to the risk profile
4.Generate hold-and-resume schedule with day-by-day dosing
5.Recommend bridging only if criteria met (mechanical valve, recent VTE, very high stroke risk)
6.Coordinate with proceduralist and PharmD for sign-off
7.Schedule post-procedure INR check

Periprocedural anticoagulation managed with guideline-based decisions, not gestalt.

Integrations

EHR / FHIR R4 API (Epic, Cerner, athenahealth)
Lab Integration (INR results, CBC, basic metabolic panel)
Drug Interaction Database (Lexicomp, First Databank)
ACCP / AHA Anticoagulation Guidelines Reference
PharmD Escalation Workflow
Clinical Document Generation (Visit Summaries, Counseling Sheets)

Industries

healthcare

See It In Action

A sample conversation with this agent

INR check for Robert Patel—atrial fib, on warfarin 5mg daily.
Pulling Robert's record. Today's INR: 2.4 (target range 2–3 for non-valvular AFib). Last INR 8 days ago: 2.6. He's in range. Module 4 disease control: TTR over the last 90 days is 71%—above the 65% benchmark. No new medications, no GI bleeding signals, no missed doses reported. Current dose appropriate. Recommend continuing 5mg daily, recheck INR in 4 weeks per the standard cadence. Generating the visit summary now. Anything else to flag for this encounter?
He just started azithromycin yesterday for a respiratory infection.
ALERT. Azithromycin has a moderate-to-significant interaction with warfarin via CYP3A4 and protein-binding effects—INR can rise 20–40% within 5–10 days. Recommended action: (a) check INR at day 5 of the antibiotic course, (b) anticipate a possible 10–15% dose reduction depending on the result, (c) counsel Robert on bleeding signs (gingival bleeding, hematuria, melena, unusual bruising). Escalating to PharmD with the interaction flag and the proposed monitoring change. The macrolide course is short, so I'd expect to return to baseline dose within 2 weeks of completing the antibiotic. Want me to generate the patient counseling sheet?
He needs a colonoscopy in 3 weeks. Bridge or hold?
Periprocedural decision. Robert's CHA2DS2-VASc is 4 (moderate-high stroke risk), HAS-BLED is 2 (moderate bleed risk on procedure). Per ACCP and AHA guidance for non-valvular AFib without recent stroke or mechanical valve: routine colonoscopy is low-to-intermediate bleed risk—bridging is generally NOT recommended for this profile, and bridging actually increases bleeding without clear thromboembolic benefit. Recommended: hold warfarin 5 days pre-procedure, no LMWH bridge, resume the evening of the procedure if hemostasis is good, INR check at day 7 post-resumption. Routing this plan to the gastroenterologist and PharmD for confirmation. Want me to package the periprocedural protocol now?