title: Implications of an inpatient warfarin dosing nomogram on safety outcomes post-discharge.
abstract: Many hospitals have implemented warfarin dosing nomograms to improve patient safety. To our knowledge, no study has assessed the impact inpatient warfarin initiation has in both medical and surgical patients, on safety outcomes post discharge. To evaluate the impact of a suggested institutional nomogram for the initiation of warfarin, the primary endpoint was the incidence of bleeding throughout follow up. Secondary endpoints included the composite of INR changes ≥0.5/day and INR >4. Patients were followed for a period of 2 weeks post-discharge. The composite endpoint was evaluated for an effect on reaching therapeutic INR, time to reach therapeutic INR, and bleeding events throughout follow up. A single center retrospective study comparing the safety of adherence vs. non-adherence to a warfarin nomogram. A total of 206 patients were included, 73 patients in the nomogram adherence vs. 133 in the nonadherence arm. There was no difference in the proportion of patients who bled throughout the follow up period, adherence 9.6% vs. nonadherence to the nomogram 13.5%, p = 0.407. There was however a statistical difference in the mean total number of bleeding events, 0.096 (7/73) in the adherence vs. 0.158 (21/133) in the non-adherence arm, p = 0.022. There was also no difference in the composite endpoint, 19.2% in the adherence vs. 28.6% in the non-adherence arm p = 0.180. A positive correlation between the inpatient composite and risk of bleeding throughout follow up was noted. The findings of this study support adherence to the nomogram as opposed to non-adherence.
authors.affiliation: School of Pharmacy, Lebanese American University, Po Box 36, Byblos, Lebanon. nibal.chamoun@lau.edu.lb.
authors.forename: Nibal
authors.identifier: http://orcid.org/0000-0002-0987-296X
authors.initials: N
authors.lastname: Chamoun
authors.affiliation: Baystate Medical Center, Springfield, MA, USA.
authors.forename: C Gabriela
authors.initials: CG
authors.lastname: Macías
authors.affiliation: UMass Memorial Medical Center, Worcester, MA, USA.|Massachusetts College of Pharmacy and Health Sciences, Worcester, MA, USA.|University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Donovan
authors.affiliation: UMass Memorial Medical Center, Worcester, MA, USA.|University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Klugman
authors.affiliation: UMass Memorial Medical Center, Worcester, MA, USA.|University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Joel
authors.initials: J
authors.lastname: Gore
authors.affiliation: School of Pharmacy, Lebanese American University, Po Box 36, Byblos, Lebanon.
authors.forename: Pascale
authors.initials: P
authors.lastname: Salameh
authors.affiliation: UMass Memorial Medical Center, Worcester, MA, USA.|Massachusetts College of Pharmacy and Health Sciences, Worcester, MA, USA.|University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Maichi T
authors.initials: MT
authors.lastname: Tran
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D007297:Inpatients; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D010351:Patient Discharge; D061214:Patient Safety / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014859:Warfarin / Q000008:administration & dosage*; D016903:Drug Monitoring
chemical_list: D014859:Warfarin
keywords: Anticoagulation; Inpatient; Nomograms; Safety; Warfarin