Improving Anticoagulation Control in Hospitalized Elderly Patients on Warfarin
Article first published online: 26 JAN 2010
© 2010, Copyright the Authors. Journal compilation © 2010, The American Geriatrics Society
Journal of the American Geriatrics Society
Volume 58, Issue 2, pages 242–247, February 2010
How to Cite
Gouin-Thibault, I., Levy, C., Pautas, E., Cambus, J.-P., Drouet, L., Mahé, I., Bal dit Sollier, C., Horellou, M.-H., Golmard, J.-L. and Siguret, V. (2010), Improving Anticoagulation Control in Hospitalized Elderly Patients on Warfarin. Journal of the American Geriatrics Society, 58: 242–247. doi: 10.1111/j.1532-5415.2009.02675.x
- Issue published online: 27 JAN 2010
- Article first published online: 26 JAN 2010
- warfarin management;
- computer-assisted warfarin management;
- quality of anticoagulation;
- anticoagulation clinics
OBJECTIVES: To determine the effect of patient characteristics and of specific guidelines that were developed for managing warfarin therapy in older adults and included in an in-house computer program on anticoagulation quality.
DESIGN: Thirteen-month observational study.
SETTING: Acute care, extended care, and rehabilitation geriatric wards of a teaching hospital in Paris, France.
PARTICIPANTS: Hospitalized patients (N=307, mean age 86.1 ± 6.1) treated with warfarin with a therapeutic international normalized ratio range of 2.0 to 3.0.
INTERVENTION: Patients were assigned according to care unit to the computer-generated dosing group (CGD) or the standard management group (SM; usual physician-based care).
MEASUREMENTS: Relationships between anticoagulation quality criteria and covariates (age, sex, warfarin indication, treatment phase, follow-up duration, model of care).
RESULTS: According to multivariate analysis, only model of care and follow-up duration independently influenced anticoagulation control; the proportion of time within therapeutic INR range 2.0 to 3.0 was significantly greater in the CGD group than in the SM group (59% vs 48%, P=.004). When a wider INR range was analyzed (1.8–3.2), the proportion of time within range was 73% versus 64% (P=.006). Use of the computer was associated with fewer days with INRs greater than 3, a smaller percentage of INRs of 4 or greater, a longer time to the first INR of 4.0 or greater, and a smaller mean number of INRs per month than SM (all P<.01).
CONCLUSION: Initiation regimen and long-term rules that have specifically been developed and included in a computerized dosage program improve quality of anticoagulation in elderly inpatients, allowing them to benefit from a quality of care as high as that of younger ambulatory patients.