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 Scopus citations

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

Keywords

  • anticoagulation
  • medical computing
  • warfarin

ASJC Scopus subject areas

  • Internal Medicine

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    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