Initiation of warfarin therapy: comparison of physician dosing with computer-assisted dosing

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 th...

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Bibliographic Details
Published in:Journal of general internal medicine : JGIM 1987-05, Vol.2 (3), p.141-148
Main Authors: White, R H, Hong, R, Venook, A P, Daschbach, M M, Murray, W, Mungall, D R, Coleman, R W
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Clinical Trials as Topic
Drug Therapy, Computer-Assisted
Follow-Up Studies
Humans
Middle Aged
Physicians
Prothrombin Time
Random Allocation
Therapy, Computer-Assisted
Time Factors
Warfarin - administration & dosage
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Summary: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 out-performed 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 less than 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.
ISSN:0884-8734
1525-1497
DOI:10.1007/BF02596140