Bayesian Pharmacokinetic/Pharmacodynamic Forecasting of Prothrombin Response to Warfarin Therapy

Svec, Jennifer M.; Coleman, Robert W.; Mungall, Dennis; Ludden, Thomas M.

doi:10.1097/00007691-198506000-00006

Cited by 36 publications

(13 citation statements)

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“…In general terms, two main types of expert system are available: rule-based systems, where operations are performed subject to a set of rules obtained from a single or group of specialists in a given field; and probabilistic systems where evidence is weighed and then the best option calculated according to Bayes Theorem (Lundsgaarde, 1987). Anticoagulation systems are also essentially of two further types, being concerned either primarily with initiation of warfarin therapy (Sun & Chang, 1995;Svec et al, 1985) or with maintenance therapy (Wilson & James, 1984;Mariani et al, 1990;Ryan et al, 1989). Initiation modules tend to use Bayesian predictions allied with pharmacodynamic modelling.…”

Section: Discussionmentioning

confidence: 99%

“…Anticoagulation systems are also essentially of two further types, being concerned either primarily with initiation of warfarin therapy ( Sun & Chang, 1995; Svec et al , 1985 ) or with maintenance therapy ( Wilson & James, 1984; Mariani et al , 1990 ; Ryan et al , 1989 ). Initiation modules tend to use Bayesian predictions allied with pharmacodynamic modelling.…”

Section: Discussionmentioning

confidence: 99%

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Review of computerized decision support systems for oral anticoagulation management

et al. 1998

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Summary. Computerized decision support systems (CDSS)are available to assist clinicians in the therapeutic management of oral anticoagulation. We report the findings relating to CDSS for oral anticoagulation management of a primary-care-based systematic review which largely focused on near-patient testing. Seven papers were reviewed which covered four different systems. The methodology of these papers was generally poor, although one randomized controlled trial showed improved therapeutic control associated with computerized management compared with human performance.Keywords: computerized decision support system, oral anticoagulation.Therapeutic monitoring of warfarin therapy requires two key elements to be undertaken if it is to be successful: the measurement of the INR and an interpretation of the result in order to advise on dosage of warfarin and when the next test should be performed. The element of interpretation has traditionally been the consultant haematologist's role, with primary care physicians expressing concern at their perceived lack of clinical knowledge to undertake this service (Taylor et al, 1993).Computerized decision support systems (CDSS) can be defined as 'programmes designed to give advice about significance of results and their implications for subsequent patient management ' (Hobbs et al, 1997). The principle underlying the utilization of CDSS within any clinical environment is that a reproducible decision will be made given a certain set of data. Many clinical situations have been investigated to ascertain the utility of CDSS; however, few have demonstrated enduring effect. One area where success has been reported is the field of oral anticoagulation management.The principle advantages to CDSS are deemed to be reproducibility of interpretation within centres, standardization between centres, and ease of performance assessment. If these features are present, CDSS could enable non-specialist clinicians to undertake tasks which have previously been the domain of the specialist. Anticoagulation CDSS has been reported as enabling non-specialist staff to undertake therapeutic monitoring within hospital clinics, and also to provide accurate data for audit (Hobbs et al, 1997).This paper reports on the literature identified as part of a systematic review which reported on near-patient testing, CDSS and rapid transit systems relevant to or within primary care (Hobbs et al, 1997). METHODSAs part of a systematic review of near-patient tests in primary care (Hobbs et al, 1997), computer searches were undertaken covering the period 1986-95 using the following literature databases: Medline; BIDS (Bath-ISI-DataService); Science Citation Index; Index to Scientific and Technical Proceedings, Department of Health; EMBASE; GP Lit Data Base, Royal College of General Practitioners; and CINHAL. The key words used for CDSS were: computerized decision support, expert systems, electronic data interchange and computer communication networks; in combination with: family practice, primary (health) care, physician...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Review of computerized decision support systems for oral anticoagulation management

et al. 1998

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“…Several were developed using simple linear or log-linear direct effects pharmacodynamic models for the warfarin doseresponse relationship and were not included in this research (see (32)(33)(34)(35)(36)(37)(38)). Of the remaining models, six did not include adequate details of parameter estimates or error models to enable simulation (e.g.…”

Section: Published Pkpd Modelsmentioning

confidence: 99%

Development of a Bayesian Forecasting Method for Warfarin Dose Individualisation

Wright

Duffull

2011

Pharm Res

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“…The Bayesian regression computer program is described in detail elsewhere (Drug Calc; MediFore, Lansing, MI). [9][10][11] Construction of the Graphic Nomogram…”

Section: Bayesian Regression Computer Programmentioning

confidence: 99%

A Graphic Nomogram for Warfarin Dosage Adjustment

1999

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We assessed the ability of a graphic nomogram to adjust steady-state warfarin dosages and to predict international normalized ratios (INR) after a dosage change, compared with an anticoagulation clinic pharmacist and a Bayesian regression computer program. Study subjects were 108 men and 3 women receiving warfarin anticoagulation. In all patients the median absolute errors in predicted INR values for the nomogram, computer program, and pharmacist were 0.33, 0.46, and 0.48, respectively. The nomogram was significantly more precise than both other methods (p=0.036). In a subset of 50 patients who required dosage reductions, the median absolute INR prediction errors for the nomogram, computer program, and pharmacist were 0.35, 0.54, and 0.48 respectively. The nomogram was significantly more precise than the pharmacist (p=0.005) and computer (p=0.002). The ability to provide more precise dosage reductions of warfarin may be of clinical importance in light of current recommendations for higher-intensity warfarin therapy and maintenance of higher INR values. Prospective validation of the performance of this nomogram in a routine clinical setting is warranted.

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Bayesian Pharmacokinetic/Pharmacodynamic Forecasting of Prothrombin Response to Warfarin Therapy

Cited by 36 publications

References 0 publications

Review of computerized decision support systems for oral anticoagulation management

Review of computerized decision support systems for oral anticoagulation management

Development of a Bayesian Forecasting Method for Warfarin Dose Individualisation

A Graphic Nomogram for Warfarin Dosage Adjustment

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