Initiation of warfarin therapy: comparison of physician dosing with computer-assisted dosing.
In a prospective, randomized study at two university hospitals, the authors examined how effectively housestaff physicians (n = 36) managed the initiation of warfarin therapy compared with a computer-assisted dosing regimen (n = 39) using the software program Warfcalc, which was managed by one of the authors. Target prothrombin time ratios were selected by the physicians. Study endpoints included: the time to reach a therapeutic prothrombin ratio, the time to reach a stable therapeutic dose, the number of patients transiently overanticoagulated, the number of bleeding complications, and the accuracy of the predicted maintenance dose, which was assessed at steady-state 10-14 days later. Computer-assisted dosing consistently out-performed the physicians: a stable therapeutic dose was achieved 3.7 days earlier (p = 0.002), fewer patients were overanticoagulated (10% versus 41%), and the predicted maintenance dose was in the therapeutic range in 85% of the computer-dosed patients versus 42% of the physician group (p less than 0.002). For physicians who did not routinely manage warfarin therapy, computer-assisted dosing improved the accuracy of dosing and shortened the time required to achieve a stable therapeutic dose.
White
R H
RH
Hong
R
R
Venook
A P
AP
Daschbach
M M
MM
Murray
W
W
Mungall
D R
DR
Coleman
R W
RW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002986:Clinical Trials as Topic; D004360:Drug Therapy, Computer-Assisted; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D010820:Physicians; D011517:Prothrombin Time; D011897:Random Allocation; D013813:Therapy, Computer-Assisted; D013997:Time Factors; D014859:Warfarin / Q000008:administration & dosage*
D014859:Warfarin