Key result
Standard-dose warfarin linked to reaching therapeutic INR ~1.6 days faster than low-dose without increased bleeding.
Why the study?
Warfarin dosages are individualized based on clinical factors, but the safety and time to target INR between low-dose and standard-dose initiation strategies in potentially warfarin-sensitive patients required evaluation.
Does a standard-dose warfarin initiation strategy (5-7.5 mg) improve time to reach target INR compared to a low-dose strategy (2.5 mg) in hospitalised patients considered sensitive to warfarin?
Observational (n=137)
Does a standard-dose warfarin initiation strategy (5-7.5 mg) improve time to reach target INR compared to a low-dose strategy (2.5 mg) in hospitalised patients considered sensitive to warfarin?
Absolute Event Rate: 7.4% vs 5.84%
In patients considered sensitive to warfarin, a 5-7.5 mg loading dose achieves therapeutic INR faster than a 2.5 mg dose without increasing the risk of bleeding.
May accelerate time to therapeutic INR with standard initiation doses in sensitive patients; case report leaves open safety and generalizability.
Warfarin dosages are individualised based on disease state, target International Normalised Ratio (INR) and potential risk factors for bleeding. This retrospective case series study compared and evaluated the safety and time to reach target INR (therapeutic INR and INR >3) of two warfarin dose initiation strategies (2.5 vs 5–7.5 mg; Groups 1 and 2, respectively) in potentially warfarin‐sensitive patients. In addition, the incidence of bleeding within 15 days of starting warfarin therapy was determined. In in all, 137 patients were included in the study. The mean (±SD) time to reach an INR ≥2.0 was 7.4 ± 2.3 vs 5.84 ± 1.82 days in Groups 1 and 2, respectively. There was no significant difference between groups in patients attaining INR >3 (p = 0.1487). In conclusion, some patients considered sensitive to warfarin could receive a loading dose of 5–7.5 mg and attain therapeutic INR faster than patients receiving 2.5 mg without an increased risk of bleeding.
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Alamri et al. (2019) conducted an observational in Hospitalised patients considered sensitive to warfarin (n=137). Low-dose warfarin initiation vs. Standard-dose warfarin initiation (5-7.5 mg) was evaluated on Time to reach an INR ≥2.0 (days). Standard-dose warfarin initiation (5-7.5 mg) attained therapeutic INR faster than low-dose (2.5 mg) initiation (mean 5.84 vs 7.4 days) without an increased risk of bleeding.
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