AI Article Synopsis
- Three different strategies exist for starting warfarin: fixed dosing (FWD), clinical dosing (CWD), and genetic-guided dosing (GWD), with GWD shown to be superior in some trials.
- In a study comparing CWD and FWD, researchers found no significant difference in time spent within the therapeutic range or in extreme INR levels between the two methods.
- The conclusion is that CWD did not provide better anticoagulation quality compared to FWD, suggesting that fixed dosing may continue to be a viable option.
Article Abstract
Different dosing strategies exist to initiate warfarin, most commonly fixed warfarin dosing (FWD), clinical warfarin dosing (CWD), and genetic-guided warfarin dosing (GWD). Landmark trials have shown GWD to be superior when compared to FWD in the EU-PACT trial or CWD in the GIFT trial. COAG trial did not show differences between GWD and CWD. We aim to compare the anticoagulation quality outcomes of CWD and FWD. This is a prospective cohort study with a retrospective comparator. Recruited subjects in the CWD (prospective) arm were initiated on warfarin according to the clinical dosing component of the algorithm published in www.warfarindosing.org. The primary efficacy outcome was the percentage time in the therapeutic range (PTTR) from day 3 to 6 till day 28 to 35. The study enrolled 122 and 123 patients in the CWD and FWD, respectively. The PTTR did not differ statistically between CWD and FWD (62.2 ± 26.2% vs. 58 ± 25.4%, p = 0.2). There was also no difference between both arms in the percentage of visits with extreme subtherapeutic international normalized ratio (INR) (<1.5; 15 ± 18.3% vs. 16.8 ± 19.1%, p = 0.44) or extreme supratherapeutic INR (>4; 7.7 ± 14.7% vs. 7.5 ± 12.4%, p = 0.92). We conclude that CWD did not improve the anticoagulation quality parameters compared to the FWD method.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11164972 | PMC |
| http://dx.doi.org/10.1111/cts.13797 | DOI Listing |
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