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Improving anticoagulation control in hospitalized elderly patients on warfarin.

Abstract：

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.

journal_name

J Am Geriatr Soc

journal_title

Journal of the American Geriatrics Society

authors

Gouin-Thibault I,Levy C,Pautas E,Cambus JP,Drouet L,Mahé I,Bal Dit Sollier C,Horellou MH,Golmard JL,Siguret V

doi

10.1111/j.1532-5415.2009.02675.x

subject

Has Abstract

pub_date

2010-02-01 00:00:00

pages

242-7

issue

eissn

0002-8614

issn

1532-5415

pii

JGS2675

journal_volume

pub_type

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Improving anticoagulation control in hospitalized elderly patients on warfarin.