Key result
Older-patient warfarin protocol predicts maintenance dosing in ~70% of cases, linked to improved TTR.
Why the study?
Does a targeted warfarin initiation protocol improve the speed and stability of achieving therapeutic INR and reduce over-anticoagulation in older people?
Case-Control
Does a targeted warfarin initiation protocol improve the speed and stability of achieving therapeutic INR and reduce over-anticoagulation in older people?
A targeted warfarin initiation protocol for older adults improves the speed and stability of achieving therapeutic anticoagulation without increasing the risk of over-anticoagulation.
May support protocol use in older adults; leaves open need for randomized confirmation before practice change.
A protocol for initiation of warfarin therapy, targeted specifically for older people and based on individual responses to initial warfarin doses, was evaluated in a case-control study. People within the protocol group: (i) received higher initial doses of warfarin, (ii) reached an international normalized ratio (INR) of 2 more quickly, (iii) spent more time with INR of 2-3 in the first week and (iv) were less likely to be over-anticoagulated. However, the proportion of people who reached an INR of 2 too quickly (in <4 days) was no greater. The protocol correctly predicted the maintenance dose range of warfarin in over 70% of cases.
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Wilkinson et al. (2003) conducted a case-control in Anticoagulation. Warfarin initiation protocol vs. Non-protocol group was evaluated on Time to reach INR of 2, time spent with INR 2-3 in the first week, and over-anticoagulation. A warfarin initiation protocol for older people correctly predicted the maintenance dose range in over 70% of cases and improved time in therapeutic range without increasing rapid over-anticoagulation.
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