coumadin therapy protocol:length of hospital stay in AF

  Sirs:  Recently I was hospitalized with Atrial Fib.  Was started on heparin protocol and coumadin.  My INR is within the therapeutic range that the cardiologist wants at this time.  I am wondering if there are any studies that I can refer to that lists length of hospitat stay while becoming stablized on the coumadin?  I was hospitalized for 4 days.  I converted before being admitted to the ICU.  My insurance agency will pay for only 2 days hospitalization.  I understand that it usually takes a minimum of 3 days to become stabilized.  If you can tell me of any articles I might use to send to the insurance company I would appreciate it to justify the length of stay.  Judith(a stubborn nursing college professor)
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Dear Judith:
This sounds like another outrageous example of an insurance company refusing to pay for appropriate care.  In my experience, it usually takes a minimum of three days to get a patient to a therapeutic INR with coumadin; sometimes it will take many more days to get to a therapeutic level safely.  Any major internal medicine or cardiology textbook will state this fact.  The Washington Manual outlines a protocol for anticoagulation with coumadin.  You could photocopy the page and send it to your insurance company.  
However, I doubt that your insurance company will be swayed by the facts.  You should ask your cardiologist to talk to the insurance company.  He would be aware of the particular details of your case, the indications for anticoagulation, and the reasons he chose to keep you in the hospital.  This sometimes can help, though certainly not always.  I wish you the best of luck.
Information provided here is of a general nature.  Specific diagnoses and treatments can only be made by your doctor.  If you would like to be seen at the Cleveland Clinic, please call 1-800-CCF-CARE for an appointment with a cardiologist.

[1georgieporgie]

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