Randomized Trial of Warfarin Nomograms
Authors: Brian F. Gage
Journal: Annals of Internal Medicine (2004)

Letters16 March 2004Randomized Trial of Warfarin NomogramsBrian F. Gage, MD, MScBrian F. Gage, MD, MScFrom Washington University, St. Louis, MO 63110.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-140-6-200403160-00025 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:In their randomized, controlled trial, Kovacs and colleagues (1) showed that initiating warfarin therapy by prescribing 10 mg on days 1 and 2 reduced the time required to achieve a therapeutic INR, compared with 5-mg doses. Their findings parallel the results of a similar trial (2) and show that starting with a higher dose of warfarin elevates the INR more rapidly.However, the risks of using this dosing scheme probably outweigh the benefits, particularly among the elderly. The primary benefit, achieving a therapeutic INR 1.4 days earlier, is small. In contrast, hemorrhagic complications caused by excessive anticoagulation ...References1. Kovacs MJ, Rodger M, Anderson DR, Morrow B, Kells G, Kovacs J, et al . Comparison of 10-mg and 5-mg warfarin initiation nomograms together with low-molecular-weight heparin for outpatient treatment of acute venous thromboembolism. A randomized, double-blind, controlled trial. Ann Intern Med. 2003;138:714-9. [PMID: 12729425] LinkGoogle Scholar2. Gedge J, Orme S, Hampton KK, Channer KS, Hendra TJ. A comparison of a low-dose warfarin induction regimen with the modified Fennerty regimen in elderly inpatients. Age Ageing. 2000;29:31-4. [PMID: 10690692] CrossrefMedlineGoogle Scholar3. O'Connell MB, Kowal PR, Allivato CJ, Repka TL. Evaluation of warfarin initiation regimens in elderly inpatients. Pharmacotherapy. 2000;20:923-30. [PMID: 10939553] CrossrefMedlineGoogle Scholar4. Roberts GW, Druskeit T, Jorgensen LE, Wing LM, Gallus AS, Miller C, et al . Comparison of an age adjusted warfarin loading protocol with empirical dosing and Fennerty's protocol. Aust N Z J Med. 1999;29:731-6. [PMID: 10630656] CrossrefMedlineGoogle Scholar5. Harrison L, Johnston M, Massicotte MP, Crowther M, Moffat K, Hirsh J. Comparison of 5-mg and 10-mg loading doses in initiation of warfarin therapy. Ann Intern Med. 1997;126:133-6. [PMID: 9005747] LinkGoogle Scholar6. Gage BF, Fihn SD, White RH. Warfarin therapy for an octogenarian who has atrial fibrillation. Ann Intern Med. 2001;134:465-74. [PMID: 11255522] LinkGoogle Scholar7. Gage BF, Eby C, Milligan PE, Banet GA, Duncan JR, McLeod HL. Use of pharmacogenetics and clinical factors to predict the maintenance dose of warfarin. Thromb Haemost. 2004;91:87-94. [PMID: 14691573] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Washington University, St. Louis, MO 63110. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoComparison of 5-mg and 10-mg Loading Doses in Initiation of Warfarin Therapy Linda Harrison , Marilyn Johnston , M. Patricia Massicotte , Mark Crowther , Karen Moffat , and Jack Hirsh Warfarin Therapy for an Octogenarian Who Has Atrial Fibrillation Brian F. Gage , Stephan D. Fihn , and Richard H. White Comparison of 10-mg and 5-mg Warfarin Initiation Nomograms Together with Low-Molecular-Weight Heparin for Outpatient Treatment of Acute Venous Thromboembolism Michael J. Kovacs , Marc Rodger , David R. Anderson , Beverly Morrow , Gertrude Kells , Judy Kovacs , Eleanor Boyle , and Philip S. Wells Randomized Trial of Warfarin Nomograms Robert J. DiDomenico Randomized Trial of Warfarin Nomograms Mark A. Crowther , Linda Harrison , and Jack Hirsh Randomized Trial of Warfarin Nomograms Theodore E. Warkentin Randomized Trial of Warfarin Nomograms Kenneth L. McCall Randomized Trial of Warfarin Nomograms Michael J. Kovacs and Philip S. Wells Randomized Trial of Warfarin Nomograms Gregory M. Peterson and Shane L. Jackson Randomized Trial of Warfarin Nomograms Richard White and William Dager Randomized Trial of Warfarin Nomograms Robert Zeller Metrics Cited byA 10 mg warfarin initiation nomogram is safe and effective in outpatients starting oral anticoagulant therapy for venous thromboembolismWarfarin Maintenance Dosing Patterns in Clinical Practice 16 March 2004Volume 140, Issue 6Page: 489KeywordsAdverse eventsDrug metabolismDrugsElderlyHemorrhageInternational normalized ratioPatient advocacyProteinsRandomized trialsVitamin K ePublished: 16 March 2004 Issue Published: 16 March 2004 Copyright & PermissionsCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...