Variation in Warfarin Dose Adjustment Practice Is Responsible for Differences in the Quality of Anticoagulation Control Between Centers and Countries
Why the study?
Does algorithm-consistent warfarin dosing improve time in therapeutic range and reduce the composite outcome of stroke, systemic embolism, or major hemorrhage in patients with nonvalvular atrial fibrillation?
Population
6,022 nonvalvular atrial fibrillation patients from 912 centers in 44 countries receiving warfarin in the…
Comparison
Algorithm-consistent warfarin dosing vs Varying degrees of non-algorithm-consistent…
Design
Cohort
Authors
Discussion
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Implication
Supports algorithm-consistent warfarin dosing for better TTR and outcomes in AF; hypothesis-generating and requires randomized confirmation before practice change.
Structured PICO
Does algorithm-consistent warfarin dosing improve time in therapeutic range and reduce the composite outcome of stroke, systemic embolism, or major hemorrhage in patients with nonvalvular atrial fibrillation?
P
Population
6,022 nonvalvular atrial fibrillation patients from 912 centers in 44 countries receiving warfarin in the RE-LY trial
I
Intervention
Algorithm-consistent warfarin dosing (no change for in-range, and 10% to 15% weekly dose changes for out-of-range International Normalized Ratio values)
C
Comparator
Varying degrees of non-algorithm-consistent warfarin dosing
O
Outcome
Patient time in therapeutic International Normalized Ratio range (TTR) and the composite outcome of stroke, systemic embolism, or major hemorrhagecomposite
Adherence to a simple warfarin dosing algorithm significantly improves time in therapeutic range and reduces the composite risk of stroke, systemic embolism, or major hemorrhage in patients with atrial fibrillation.
Limitations
- Could not verify whether providers intentionally used the algorithm
Cite This Study
Spall et al. (2012) studied this question.