Randomized Trial of Warfarin Nomograms
Authors: Richard White, William Dager
Journal: Annals of Internal Medicine (2004)

Letters16 March 2004Randomized Trial of Warfarin NomogramsRichard White, MD and William Dager, PharmDRichard White, MDFrom University of California, Davis, Sacramento, CA 95817.Search for more papers by this author and William Dager, PharmDFrom University of California, Davis, Sacramento, CA 95817.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-140-6-200403160-00023 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:The article by Kovacs and colleagues (1) presented data supporting the strategy of starting warfarin therapy using a dosage of 10 mg/d for 2 days, with dose adjustment starting on day 3 using a 10-mg initiation nomogram. We feel this approach is unsafe and, if widely used, will result in untoward outcomes.Using the widely accepted model of Theofanous and Barile for warfarin pharmacokinetics (2), we modeled the use of this 10-mg nomogram with a validated Bayesian forecasting program (3). For an elderly patient who responds with an INR of 3.0 at noon on day 3 after ...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. Theofanous TG, Barile RG. Multiple-dose kinetics of oral anticoagulants: methods of analysis and optimized dosing. J Pharm Sci. 1973;62:261-6. [PMID: 4686401] CrossrefMedlineGoogle Scholar3. White RH, Hong R, Venook AP, Daschbach MM, Murray W, Mungall DR, et al . Initiation of warfarin therapy: comparison of physician dosing with computer-assisted dosing. J Gen Intern Med. 1987;2:141-8. [PMID: 3295148] CrossrefMedlineGoogle Scholar4. Daly AK, King BP. Pharmacogenetics of oral anticoagulants. Pharmacogenetics. 2003;13:247-52. [PMID: 12724615] CrossrefMedlineGoogle Scholar5. Gage BF, Fihn SD, White RH. Management and dosing of warfarin therapy. Am J Med. 2000;109:481-8. [PMID: 11042238] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of California, Davis, Sacramento, CA 95817. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoComparison 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 Zeller Randomized Trial of Warfarin Nomograms Brian F. Gage 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 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: 488-489KeywordsBayesian methodComputersElderlyInternational normalized ratioPharmacokineticsRandomized trials ePublished: 16 March 2004 Issue Published: 16 March 2004 CopyrightCopyright © 2004 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...