Why the study?
Does a clinical algorithm for initial warfarin dosing improve the time in therapeutic range (TTR) during hospitalization compared to standard dosing in patients requiring oral anticoagulation?
Does a clinical algorithm for initial warfarin dosing improve the time in therapeutic range (TTR) during hospitalization compared to standard dosing in patients requiring oral anticoagulation?
Achieving target INR during hospitalization is highly limited regardless of the warfarin dosing regimen used, highlighting the potential advantage of direct oral anticoagulants.
Neither regimen achieved adequate inpatient TTR (~22%); reinforces caution with warfarin initiation and need for better strategies.
AIM: To perform a randomized, open-label comparison of average time in therapeutic range (TTR) of international normalized ratio (INR) using two approaches to initial warfarin dosing during hospitalization: the standard method and the one using individual patient characteristics (clinical algorithm - the studied approach). MATERIALS AND METHODS: We randomly assigned 60 patients with different indications for vitamin K antagonist therapy to the studied approach (n=31, intervention group) or to the standard method (n=29, control group). А target INR range for all patients was 2.0 to 3.0. RESULTS: The average TTR and portions of INR values within target range during the whole time of drug dosing turned out to be small. TTR was 22.4% with standard method and 21.4% with clinical algorithm, which was well below desired 60%. CONCLUSION: The opportunities for achieving target INR in inpatient settings, regardless of warfarin dosing regimen, are limited.
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Мищенко et al. (2017) studied this question.
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