[Prescribing guidance pocket chart on the initiation of warfarin therapy in a geriatric hospital: a useful but challenging tool].
Elderly patients are at high risk of over-anticoagulation and of haemorrhagic risk when on warfarin, especially during treatment induction. In Charles Foix Hospital, a 800-bed geriatric hospital, we specifically developed for in-patients older than 70 years (target INR 2.5) a simple low-dose warfarin induction regimen. The dosing recommendations were summarized on a prescribing guidance pocket chart. Eighteen months after the distribution of the chart, we conducted a one-year observational study in order to evaluate: i/ the time needed to achieve the warfarin maintenance dose; ii/ the prescriber'adherence to the recommendations; iii/ the benefit for elderly patients receiving warfarin therapy. The mean time needed to achieve the warfarin maintenance dose was 12.3 +/- 7.0 days for the 89 patients included in the study: 10.6 +/- 5.9 days for the 30 patients whose prescribers followed the recommendations versus 13.5 +/- 7.6 days for the 59 patients whose prescribers did not follow the recommendations. There is a trend to a more frequent over-anticoagulation in patients whose prescribers did not follow the recommendations. The duration of the heparin-warfarin overlap was significantly shorter when the recommendations were followed. Finally, the reasons for non-adherence to the recommendations were analyzed. This study illustrates an assessment of practice in an health care institution.
Siguret
V
V
Laboratoire d'Hématologie, Groupe Hospitalier Charles Foix-Jean Rostand (AP-HP), Ivry-sur-Seine. virginie.siguret@cfx.aphp.fr
N'Guyen
A
A
Harboun
M
M
Chevallier
A
A
Pautas
E
E
Gouin-Thibault
I
I
Berigaud
S
S
D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000592:standards; D005260:Female; D005853:Geriatrics; D019983:Guideline Adherence; D006782:Hospitals, Special; D006801:Humans; D008297:Male; D014859:Warfarin / Q000627:therapeutic use*
D000925:Anticoagulants; D014859:Warfarin