Initiation of warfarin therapy - Comparison of physician dosing with computer-assisted dosing

Richard H White, Robyn Hong, Alan P. Venook, Martha M. Daschbach, William Murray, Dennis R. Mungall, Robert W. Coleman

Research output: Contribution to journalArticle

73 Citations (Scopus)

Abstract

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 outperformed 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<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.

Original languageEnglish (US)
Pages (from-to)141-148
Number of pages8
JournalJournal of General Internal Medicine
Volume2
Issue number3
DOIs
StatePublished - May 1987

Fingerprint

Warfarin
Physicians
Prothrombin Time
Computer-Assisted Therapy
Therapeutics
Software
Prospective Studies
Hemorrhage

Keywords

  • anticoagulation
  • medical computing
  • warfarin

ASJC Scopus subject areas

  • Internal Medicine

Cite this

White, R. H., Hong, R., Venook, A. P., Daschbach, M. M., Murray, W., Mungall, D. R., & Coleman, R. W. (1987). Initiation of warfarin therapy - Comparison of physician dosing with computer-assisted dosing. Journal of General Internal Medicine, 2(3), 141-148. https://doi.org/10.1007/BF02596140

Initiation of warfarin therapy - Comparison of physician dosing with computer-assisted dosing. / White, Richard H; Hong, Robyn; Venook, Alan P.; Daschbach, Martha M.; Murray, William; Mungall, Dennis R.; Coleman, Robert W.

In: Journal of General Internal Medicine, Vol. 2, No. 3, 05.1987, p. 141-148.

Research output: Contribution to journalArticle

White, RH, Hong, R, Venook, AP, Daschbach, MM, Murray, W, Mungall, DR & Coleman, RW 1987, 'Initiation of warfarin therapy - Comparison of physician dosing with computer-assisted dosing', Journal of General Internal Medicine, vol. 2, no. 3, pp. 141-148. https://doi.org/10.1007/BF02596140
White, Richard H ; Hong, Robyn ; Venook, Alan P. ; Daschbach, Martha M. ; Murray, William ; Mungall, Dennis R. ; Coleman, Robert W. / Initiation of warfarin therapy - Comparison of physician dosing with computer-assisted dosing. In: Journal of General Internal Medicine. 1987 ; Vol. 2, No. 3. pp. 141-148.
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