title: Improving anticoagulation control in hospitalized elderly patients on warfarin.
abstract: OBJECTIVE
  To determine the effect of patient characteristics and of specific guidelines that were developed for managing warfarin therapy in older adults and included in an in-house computer program on anticoagulation quality.
  
  
  METHODS
  Thirteen-month observational study.
  
  
  METHODS
  Acute care, extended care, and rehabilitation geriatric wards of a teaching hospital in Paris, France.
  
  
  METHODS
  Hospitalized patients (N=307, mean age 86.1 +/- 6.1) treated with warfarin with a therapeutic international normalized ratio range of 2.0 to 3.0.
  
  
  METHODS
  Patients were assigned according to care unit to the computer-generated dosing group (CGD) or the standard management group (SM; usual physician-based care).
  
  
  METHODS
  Relationships between anticoagulation quality criteria and covariates (age, sex, warfarin indication, treatment phase, follow-up duration, model of care).
  
  
  RESULTS
  According to multivariate analysis, only model of care and follow-up duration independently influenced anticoagulation control; the proportion of time within therapeutic INR range 2.0 to 3.0 was significantly greater in the CGD group than in the SM group (59% vs 48%, P=.004). When a wider INR range was analyzed (1.8-3.2), the proportion of time within range was 73% versus 64% (P=.006). Use of the computer was associated with fewer days with INRs greater than 3, a smaller percentage of INRs of 4 or greater, a longer time to the first INR of 4.0 or greater, and a smaller mean number of INRs per month than SM (all P<.01).
  
  
  CONCLUSIONS
  Initiation regimen and long-term rules that have specifically been developed and included in a computerized dosage program improve quality of anticoagulation in elderly inpatients, allowing them to benefit from a quality of care as high as that of younger ambulatory patients.
authors.affiliation: Laboratoire d'Hématologie, Assistance Publique Hopitaux de Paris, Hopital Charles Foix, 7 avenue de la République, 94205 Ivry sur Seine, France. isabelle.gouin@cfx.aphp.fr
authors.forename: Isabelle
authors.initials: I
authors.lastname: Gouin-Thibault
authors.forename: Camille
authors.initials: C
authors.lastname: Levy
authors.forename: Eric
authors.initials: E
authors.lastname: Pautas
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Cambus
authors.forename: Ludovic
authors.initials: L
authors.lastname: Drouet
authors.forename: Isabelle
authors.initials: I
authors.lastname: Mahé
authors.forename: Claire
authors.initials: C
authors.lastname: Bal Dit Sollier
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Horellou
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Golmard
authors.forename: Virginie
authors.initials: V
authors.lastname: Siguret
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000925:Anticoagulants / Q000008:administration & dosage*; D016903:Drug Monitoring / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010297:Paris; D011787:Quality of Health Care; D013813:Therapy, Computer-Assisted; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D014859:Warfarin