Get access

Age- and weight-adjusted warfarin initiation nomogram for ischaemic stroke patients

Authors

  • S.-H. Yoo,

    1. Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
    Search for more papers by this author
  • S. U. Kwon,

    Corresponding author
    1. Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
    • Correspondence: Sun U. Kwon, Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeongwon-gil, Songpa-gu, Seoul 138-736, South Korea (tel.: +82 2 3010 3960; Fax: +82 2 474 4691; e-mail: sunkwon7@gmail.com).

    Search for more papers by this author
  • M.-W. Jo,

    1. Division of Epidemiology and Biostatistics, Clinical Research Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
    Search for more papers by this author
  • D.-W. Kang,

    1. Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
    Search for more papers by this author
  • J. S. Kim

    1. Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
    Search for more papers by this author

Abstract

Objectives

Specific guidelines for initial dosing of warfarin in ischaemic stroke patients have not been developed. Therefore, we have developed an age- and weight-adjusted warfarin initiation nomogram (AW-WIN) for ischaemic stroke patients and then evaluated the efficacy and safety of AW-WIN compared with physician-determined warfarin dosing (PDWD).

Methods

The age- and weight-adjusted warfarin initiation nomogram was administered to 104 acute ischaemic stroke patients between January 2008 and February 2009. A historical control group (PDWD) of 96 patients was selected from comparable patients who were discharged with warfarin during the previous year. Time-to-therapeutic international normalized ratios (INRs) and the incidence of excessive anticoagulation were compared in the AW-WIN and PDWD groups.

Results

The general characteristics, risk factors, and stroke mechanism of the AW-WIN and PDWD groups did not differ significantly. The mean time to INR ≥ 2.0 was significantly shorter in the AW-WIN than in the PDWD group (4.9 ± 0.7 vs. 6.2 ± 0.8 days, P = 0.0008). After adjustment for potential confounding variables, the AW-WIN group reached target INR faster than the PDWD group (hazard ratio, 1.76; 95% confidence interval, 1.26–2.45; P = 0.001). The time-to-therapeutic INR ≥1.7 was shorter (P = 0.0002), the proportion of patients with therapeutic INR (2–3) at 5 days was higher (P = 0.002), and the rate of excessive anticoagulation of ≥3.5 INR during hospitalization was lower (P = 0.024) in the AW-WIN than in the PDWD group.

Conclusions

AW-WIN reduces the time to target INR and the risk of excessive anticoagulation. AW-WIN may be an efficient and safe method of anticoagulation during the acute phase of ischaemic stroke.

Ancillary