Journal of General Internal Medicine

, Volume 2, Issue 3, pp 141–148

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
Original Articles

DOI: 10.1007/BF02596140

Cite this article as:
White, R.H., Hong, R., Venook, A.P. et al. J Gen Intern Med (1987) 2: 141. doi:10.1007/BF02596140

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.

Key words

warfarinanticoagulationmedical computing

Copyright information

© Society for Research and Education in Primary Care Internal Medicine 1987

Authors and Affiliations

  • Richard H. White
    • 2
  • Robyn Hong
    • 1
  • Alan P. Venook
    • 2
  • Martha M. Daschbach
    • 2
  • William Murray
    • 1
  • Dennis R. Mungall
    • 3
  • Robert W. Coleman
    • 1
  1. 1.the Department of PharmacyVeterans Administration Medical CenterPalo Alto
  2. 2.the Division of General MedicineUniversity of California, Davis, Medical CenterSacramento
  3. 3.the Clinical Research DepartmentBiotrack, Inc.Sunnyvale
  4. 4.Pharmacy Service, 119 Veterans Administration Medical CenterPalo Alto