Generated by All in One SEO v4.9.7.2, this is an llms.txt file, used by LLMs to index the site. # INR Online NZ Award winning anticoagulant management system ## Sitemaps - [XML Sitemap](https://inronline.net/sitemap.xml): Contains all public & indexable URLs for this website. ## Posts - [Updates](https://inronline.net/updates/) - [We are re-branding to POC Health Online.](https://inronline.net/we-are-re-branding-to-poc-health-online/) - [COVID, clots and shots – Protecting the vulnerable](https://inronline.net/covid-clots-and-shots-protecting-the-vulnerable/) - The severely immunosuppressed are at high risk from COVID. To be safe, they need everybody near them vaccinated. Coagulation Conversation - [Review – CPAMS at 10 years](https://inronline.net/review-cpams-at-10-years/) - CPAMS has now been running in New Zealand for 10 years. The first pilot was run in 2010 and now over 6000 patients are regularly managed using this service. We have carried out a review to see if the high level of anticoagulant control achieved during the original pilot is still maintained. The results show - [Personal Protection Equipment (PPE) Guidelines](https://inronline.net/personal-protection-equipment-ppe-guidelines/) - The Ministry of Health released guidelines on the use of PPE for healthcare workers (27th March 2020) PPE Guidance Pharmacists were categorised as low priority with a low risk of transmission.You should use the same category as phlebotomists for collecting blood samples. It is recommended that you wear gloves for collecting samples and finger-prick test and - [COVID 19 Information for patients](https://inronline.net/covid-19-information-for-patients/) - During the Covid-19 pandemic we want to keep your warfarin testing (INR) as safe as possible. During this time it is recommended that you have as little contact with other people as possible, therefore some changes to your warfarin testing may be necessary. The following should help. If you are unwell, especially if you have - [COVID-19 Information for Pharmacists](https://inronline.net/covid-19-information-for-pharmacists/) - During the Covid-19 pandemic we want to keep warfarin testing (INR) as safe as possible. The following information is to help you maintain safe testing. If a patient attends your pharmacy with symptoms; fever, sore throat, cough or difficulty breathing, they should be sent home immediately and advised to contact Healthline. DO NOT do an ## Pages - [Home](https://inronline.net/) - Online software to help you care for your patients on warfarin Improved safety Greater convenience Better care The future of warfarin management Find out more INR Online Updates COVID, clots and shots – Protecting the vulnerable Review – CPAMS at 10 years Personal Protection Equipment (PPE) Guidelines COVID 19 Information Information For Pharmacists Information For Patients - [Training Videos](https://inronline.net/resources/training-videos/) - The password for the training videos is ‘INRTrain‘ Adding an INR Result from INR Online on Vimeo. Add A High Result from INR Online on Vimeo. Patient Overview from INR Online on Vimeo. Creating Patient from INR Online on Vimeo. - [CoaguChek Link](https://inronline.net/resources/coaguchek-link/) - Powerpoint presentation, set up of CoaguChek XS Pro and INR Online's CoaguChek Link Follow the power point above for instructions on how to set up the CoaguChek with INR Online You can also download the PDF instructions here - [Herbal Remedies](https://inronline.net/information/warfarin-information/herbal-remedies/) - Many medicines, including herbal remedies, affect warfarin control. The following are some examples but this is not a comprehensive list. Be aware of potential interactions especially in products where the details of the content are uncertain. Complementary Medicines which may Increase the Anticoagulant Effect Danshen Dong Quai Ginger Horse chestnut Papain/Papaya extract Vitamin E >400iu/day - [Contact Us](https://inronline.net/contact-us/) - INR Online Ltd Phone: 0800 033 066 Email: support@pochealth.online Physical Address: Unit 1D,85 The Square,Bryants Building,Palmerston North. Postal Address: P.O. Box 2026,Palmerston North, 4410. Please note that we are IT Providers and as such are unable to offer medical advice. Please contact your pharmacist or GP for help. We are re-branding to POC - [How to use INR Online](https://inronline.net/about-us/how-to-use-inr-online/) - INR Online is available on the internet so neither your clients nor your organisation need buy any software. It’s Simple It can be used in a Pharmacy or a Doctor’s surgery It can be used with point-of-care testing or laboratory test results. Each day medically trained staff can check to see who is due for - [Warfarin Overdose](https://inronline.net/information/warfarin-guidelines/warfarin-overdose/) - Patient bleeding High risk of bleeding Low risk of bleeding Treatment strategy for warfarin over-anticoagulation If a patient has a high INR consider the following possible causes New medication Concomitant illness Change in diet Change in activity An elevated INR can significantly increase the risk of death from haemorrhage Smart Phone app There is a - [Therapeutic Ranges](https://inronline.net/information/warfarin-guidelines/therapeutic-ranges/) - INR Clinical state 2.0 – 2.5 DVT prophylaxis 2.0 – 3.0 Treatment of DVT/PE Systemic embolus atrial fibrillation TIAs LV mural thrombus Mitral valve repair 2.5 – 3.5 Tissue heart valves Mechanical prosthetic heart valves implanted after 1990 Recurrent DVT/PE 3.0 – 3.5 DVT/PE with lupus anticoagulant (a lower range may be sufficient) Mechanical prosthetic - [Loading Dose](https://inronline.net/information/warfarin-guidelines/loading-dose/) - Day INR Dose of Warfarin 1 5mg 2 5mg 3 5mg 4 2.3 8mg7mg6mg5mg4mg3mg2mg1mgnil 6+ If INR therapeutic use day 4 dose as maintenance dose otherwise increase the dose 1mg if sub-therapeutic or reduce the dose by 1mg if the dose is above the range by - [Duration of treatment](https://inronline.net/information/warfarin-guidelines/duration-of-treatment/) - Clinical Condition Duration of Therapy Calf DVT precipitating factor* 6 weeks to 3 months Spontaneous 3 months Proximal DVT precipitating factor* 3 months Spontaneous 3 – 6 months Pulmonary Embolus 3 – 6 months Recurrent DVTs or PEs (more than 2) Lifelong Muscular vein thrombosis Nonsteroidal anti-inflammatories for 7 days Rescan if symptoms unchanged or worse - [Resources](https://inronline.net/resources/) - If you cant find what you are looking for here please contact us - [Information](https://inronline.net/information/) - For pharmacists - [Pharmacy Service](https://inronline.net/pharmacy-service/) - How does it work? The patient visits your pharmacy Has a finger prick blood testThe results are automatically transferred to INR Online The computer recommends a dose and prints out a calendar The results are sent to the GP. The patient receives an email reminder for the next test What do I need? You need - [CPAMS Documents](https://inronline.net/resources/cpams-documents/) - Patients Patient registration and consent form CPAMS case studies Letter to patient – template Patient Information Download General Practitioners and Primary Care GP referral form Add Organisation/Doctor form Getting Started Requirements for providing the service Standing order Service Documents Service specification Invoicing and reporting Community Pharmacy Agreement | Te Whatu Ora website - [Anticoagulant Treatment](https://inronline.net/information/medical-conditions/anticoagulant-treatment/) - Oral anticoagulants in New Zealand Warfarin and dabigatran (Pradaxa) are the commonly used oral anticoagulants. Rivaroxaban is available for prophylaxis following orthopaedic procedures on special authority and Apixaban is available but not funded. Low Molecular Weight Heparin Enoxaparin (Clexane) and Dalteparin (Fragmin) are available in New Zealand. Treatment is given subcutaneously Treatment is given once - [Pulmonary Embolus](https://inronline.net/information/medical-conditions/pulmonary-embolus/) - What is a pulmonary embolus? A pulmonary embolus (PE) occurs when part of a blood clot somewhere else in the body breaks off and travels to the lungs. The embolus could come from a deep vein thrombosis in the leg or the pelvis. The floating piece of clot blocks the blood supply to the lungs. - [Venous Thrombosis](https://inronline.net/information/medical-conditions/venous-thrombosis/) - These clots form in veins deep inside the leg. The veins involved cannot be seen. These most commonly form in the leg veins but can occur in other parts of the body such as the arms or intestines. A deep vein thrombosis can present with the following symptoms. Pain - this can be anywhere in - [What is INR Online?](https://inronline.net/about-us/what-is-inr-online/) - If you have patients on warfarin, INR Online can help you. Approximately 1% of the population take warfarin regularly with the number growing as more people with atrial fibrillation are put on long-term treatment. As a health professional you know that good warfarin control is essential to provide safe treatment, but anticoagulant monitoring can be challenging - [About Us](https://inronline.net/about-us/) - Awards Regional winner - ANZ Flying Start Business Plan Competition 2013 Finalist - New Zealand Trade and Enterprise: Focus on Health Challenge. 2009 Winner - MidCentral District Health Award for Innovation. 2008 Publications The community pharmacy- based anticoagulation management service achieves a consistently high standard of anticoagulant care. New Zealand Medical Journal An audit of anticoagulant - [Risk Factors](https://inronline.net/information/warfarin-guidelines/risk-factors/) - Risk factors for bleeding Age >65 Albumin <30g/L Baseline INR >1.5 Bilirubin >20µmol/L PCV - [How it works](https://inronline.net/about-us/how-it-works/) - Log-on with your own user name and password.Your home page will show how many patients are due for a test today and how many are overdue. Add a new result Select Add new result and enter the INR result. Immediately you will be given a dose recommendation and the date of the next test. If - [Terms and Conditions](https://inronline.net/terms/) - The INR Online Website (“Website” or ” Site”) is a hosted service operated by INR Online Ltd. (“INR Online”). Any use of the Website is subject to the following Terms and Conditions of Use (“Terms and Conditions”). Your use of the Website will constitute your acceptance of these terms and conditions. 1. Your Account and - [Surgery](https://inronline.net/information/warfarin-information/surgery/) - If you have a patient about to undergo surgery you should advise them to contact their doctor to plan the best way to manage their warfarin treatment. The doctor will need to consider the benefits versus the risks of stopping your warfarin. Patients with a low risk of a blood clot at the time of surgery may be - [Pain Killers](https://inronline.net/information/warfarin-information/pain-killers/) - Aspirin It is recommended that people on warfarin avoid aspirin or aspirin containing medicines as these can increase the risk of bleeding.Some people with a history of stroke or heart attack may be put on aspirin and warfarin. This combination should only be taken on the recommendation of a doctor. Anti inflammatories Voltaren, Brufen, Naproxen - [Diet](https://inronline.net/information/warfarin-information/diet/) - Small changes in diet do not affect warfarin control, but significant changes can. If your patient plans to go on a weight loss diet make sure they discuss this with their doctor first. Green vegetables Warfarin works by blocking the action of vitamin K. Green vegetables contain vitamin K and therefore a diet high in green - [New Medication](https://inronline.net/information/warfarin-information/new-medication/) - A number of drugs and foods can change the effect of warfarin. Check for drug Interactions Starting or stopping medication When a patient changes their medication it is important to consider the effect it may have on their warfarin control.If a patient starts new medication that can influence warfarin control you should check the INR - [Visiting the Dentist](https://inronline.net/information/warfarin-information/visiting-the-dentist/) - You should advise your patients on warfarin to inform their dentist that they are taking an anticoagulant. Many dental procedures - including a simple extraction - can be carried out on warfarin. Many dentists use local measures to stop the bleeding from a dental socket after an extraction. Anticoagulant treatment may need to be stopped for - [Pregnancy](https://inronline.net/information/warfarin-information/pregnancy/) - If a patient informs you that she thinks she could be pregnant, you should stop warfarin immediately. An urgent pregnancy test should be considered. Advise your patient to contact her doctor as soon as possible. She may need treatment with LMW Heparin injections during pregnancy. Warfarin can affect the baby especially around 10 weeks of pregnancy. - [Missed doses](https://inronline.net/information/warfarin-information/missed-doses/) - If your patient misses a dose of warfarin they should not take two doses on the same day. It is safer to miss a dose than double the dose. Avoid taking double doses! Understanding warfarin doses Warfarin dosing can be confusing. Some people need quite small dose changes to control their treatment. We do not - [Bleeding](https://inronline.net/information/warfarin-information/bleeding/) - Minor Bleeding Bruising or minor bleeding such as bleeding gums and slight spotting from the nose is quite common for people on warfarin. If this happens occasionally you do not need to worry. However if it becomes a persistent problem it is sensible to get an INR check and talk to the doctor. Major bleeding You - [Warfarin Information](https://inronline.net/information/warfarin-information/) - What is Warfarin? Warfarin is an oral anticoagulant. (brand names - Coumadin and Marevan) Warfarin pills are taken every day to slow normal blood clotting What is treated with Warfarin? Deep vein thrombosis Painful swollen legs Pulmonary embolus Clots on the lung Heart attacks Clots in the coronary vessels Heart valves To prevent clotting on - [Drug Interactions](https://inronline.net/information/warfarin-guidelines/drug-interactions/) - Drug Interactions One of the reasons warfarin patients require close monitoring is that a number of drugs and foods impact on its effectiveness. Some drugs taken with warfarin will increase the effects of the warfarin, while others will work against it. Drugs Expected to Increase the Anticoagulant Effect of Warfarin Allopurinol Amiodarone Aspirin Bezafibrate Cefotetan - [Warfarin Guidelines](https://inronline.net/information/warfarin-guidelines/) - The international normalised ratio (INR) is used to monitor patients receiving warfarin. Warfarin has a narrow therapeutic range, so INR monitoring is necessary to avoid complications from both over-dosage (which increases the risk of bleeding) and under-dosage (which may result in clots). Oral Anticoagulant therapy There are two preparations of warfarin (Coumadin and Marevan) in - [Medical Conditions](https://inronline.net/information/medical-conditions/) - Venous Thrombosis Pulmonary Embolus Atrial Fibrillation Anticoagulant Treatment - [Atrial Fibrillation](https://inronline.net/information/medical-conditions/atrial-fibrillation/) - Atrial fibrillation is an abnormal rhythm of the heart. It can be an intermittent (paroxysmal) or chronic condition.In atrial fibrillation the upper chambers of the heart (or atria) do not work correctly because of abnormal electrical activity. Blood is not forcefully moved out of these chambers and becomes ‘static’, which allows blood clots to form - [Sitemap](https://inronline.net/sitemap/) - About Us Advantages of INR Online How it works How to use INR Online What is INR Online? Contact Us Home Information Medical Conditions Anticoagulant Treatment Atrial Fibrillation Pulmonary Embolus Venous Thrombosis Warfarin Guidelines Drug Interactions Duration of treatment Loading Dose Risk Factors Therapeutic Ranges Warfarin Overdose Warfarin Information Bleeding Diet Herbal Remedies Missed doses - [Advantages of INR Online](https://inronline.net/about-us/advantages-of-inr-online/) - Advantages for you INR online is run entirely over the internet, this gives users major advantages. No installation of software Accessible on any computer worldwide with internet access Updates happen automatically, which means you are always using the latest version No more tedious backups. INR online automatically backs-up its data to independent servers Patients can ## My Templates - [Default Kit](https://inronline.net/?elementor_library=default-kit) ## Categories - [Uncategorized](https://inronline.net/category/uncategorized/) - [News](https://inronline.net/category/news/)