What question did this study set out to answer?

To develop and evaluate a multicomponent warfarin management program designed to decrease the frequency of major bleeding complications in older adults.

November 7, 2000Annals of Internal Medicine

A Multicomponent Intervention To Prevent Major Bleeding Complications in Older Patients Receiving Warfarin

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Why the study?

Does a multicomponent program of management of warfarin therapy reduce major bleeding in older patients starting warfarin?

Population

n=325 patients 65 years of age or older who started warfarin therapy during hospitalization, US-based.

Comparison

Multicomponent program of management of warfarin… vs Usual care by their primary physicians for 6…

Design

RCT, Stratified according to baseline risk for major bleeding and randomly…

Follow-up

6 months

Authors

RBRebecca J. BeythGeneral / Preventive / Lipids

Discussion

Member takes

Implication

Supports multicomponent warfarin programs for older initiators to cut bleeding; confirms RCT efficacy of education, self-monitoring, and protocols.

Key Points

To develop and evaluate a multicomponent warfarin management program designed to decrease the frequency of major bleeding complications in older adults.
Randomized controlled trial of 325 hospitalized patients aged 65 years or older initiating warfarin, assigned to a 6-month multicomponent intervention (n = 163) or usual care (n = 162).
The intervention incorporated patient education, patient participation training, self-monitoring of prothrombin time, and guideline-based dosing protocols.
Cumulative incidence of major bleeding at 6 months was significantly lower in the intervention group than in the usual care group (5.6% vs. 12.0%; P = 0.0498).
The proportion of time that the international normalized ratio remained within the therapeutic range over 6 months was higher with the intervention than usual care (56% vs. 32%; P < 0.001).
Rates of death and recurrent venous thromboembolism were similar between the intervention and usual care groups at 6 months.

Structured PICO

Does a multicomponent program of management of warfarin therapy reduce major bleeding in older patients starting warfarin?

Population

n=325 patients 65 years of age or older who started warfarin therapy during hospitalization, US-based (single center).

Intervention

Multicomponent program of management of warfarin therapy (patient education, training to increase patient participation, self-monitoring of prothrombin time, and guideline-based management of warfarin dosing) for 6 months (n=163).

Comparator

Usual care by their primary physicians for 6 months (n=162).

Outcome

Major bleeding at 6 months.safety

A multicomponent warfarin management program including patient education, self-monitoring, and guideline-based dosing significantly reduced major bleeding in older patients over 6 months.

Limitations

Generalizability remains to be demonstrated
Cost-effectiveness remains to be demonstrated

Cite This Study

Rebecca J. Beyth (2000) studied this question.

synapsesocial.com/papers/6a7e4be416134f106bf7152f https://doi.org/10.7326/0003-4819-133-9-200011070-00010

Topics

Atrial fibrillation Persistent AF management Anticoagulation in AF

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Implication

Supports multicomponent warfarin programs for older initiators to cut bleeding; confirms RCT efficacy of education, self-monitoring, and protocols.

A Multicomponent Intervention To Prevent Major Bleeding Complications in Older Patients Receiving Warfarin

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Topics

A Multicomponent Intervention To Prevent Major Bleeding Complications in Older Patients Receiving Warfarin

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Also Consider

Topics

Also Consider