Key result
A 10-mg warfarin initiation nomogram achieves target INR within 5 days in ~86% of patients.
Why the study?
Initiation of warfarin therapy is a clinical challenge and the efficacy and safety of the 10-mg warfarin initiation nomogram in real-life practice needed evaluation.
Does a 10-mg warfarin initiation nomogram improve the achievement of therapeutic INR in outpatients starting concurrent warfarin and low-molecular-weight heparin?
Cohort (n=841)
No
Does a 10-mg warfarin initiation nomogram improve the achievement of therapeutic INR in outpatients starting concurrent warfarin and low-molecular-weight heparin?
The 10-mg warfarin initiation nomogram is effective and safe in real-world practice, achieving early therapeutic INR in 86% of patients within 5 days.
Answers are grounded in this paper and cite their sources.
Supports 10-mg nomogram efficacy and safety in routine care; extends RCT findings to real-world outpatients but leaves practice change open.
Initiation of warfarin therapy is a clinical challenge. A 10-mg warfarin initiation nomogram was recently validated in a randomized controlled trial. We sought to determine the efficacy and safety of this 10-mg warfarin initiation nomogram in 'real-life' daily practice. A retrospective cohort including all outpatients beginning concurrent treatment with warfarin and low-molecular-weight heparin over a 24-month period in our Thrombosis Unit was reviewed. Eight hundred and forty-one patients were included; of them, 640 (76.1%) were started on the nomogram. The nomogram was entirely followed in 324 patients (38.5%). The efficacy and safety profile was similar to that observed in the original clinical trial; 86% of patients managed according to the nomogram reached the international normalized ratio target of 2.0-3.0 within 5 days. Mean duration of low-molecular-weight heparin treatment was 6.0 +/- 1.9 days, and 3.7% of patients had an international normalized ratio of at least 5.0 in the first 4 weeks of treatment. The 10-mg nomogram effectively results in an early therapeutic international normalized ratio with a good safety profile in 'real-life' daily practice.
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Wells et al. (2009) conducted a cohort in Patients requiring anticoagulation (n=841). 10-mg warfarin initiation nomogram was evaluated on Reaching international normalized ratio target of 2.0-3.0 within 5 days. Management according to the 10-mg warfarin initiation nomogram resulted in 86% of patients reaching the target INR within 5 days, with 3.7% having an INR ≥5.0 in the first 4 weeks.
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