Multicentre randomised study of computerised anticoagulant dosage

Poller, L.; Shiach, C.; MacCallum, PK; Johansen, AM; Münster, Anna-Marie Bloch; Magalhães, Ana Paula Nogueira de; Jespersen, Jørgen

doi:10.1016/s0140-6736(98)04147-6

Cited by 201 publications

(142 citation statements)

References 7 publications

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“…More extensive use of computer-based algorithms for does adjustment of anticoagulants could help avoid systemic underanticoagulation. [42][43][44][45][46] We found that the relative risk of thromboembolic events increased significantly when the international normalized ratio exceeded 5. This reflects the curvilinear association between ratio levels and risk of thromboemboli that we identified in 7 of 16 studies included in our analysis.…”

Section: Discussionmentioning

confidence: 99%

Anticoagulation intensity and outcomes among patients prescribed oral anticoagulant therapy: a systematic review and meta-analysis

Oake¹,

Jennings²,

Forster³

et al. 2008

Canadian Medical Association Journal

148

124

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O ral anticoagulant therapy is essential for the treatment and prevention of many thromboembolic disorders. Since anticoagulants can cause serious adverse events, 1-3 physicians monitor the international normalized ratios of patients taking these drugs to ensure that their ratios fall within a target range.An international normalized ratio of 2-3 is the most common target range. Results of previous studies revealed an increased risk of bleeding among patients whose ratios exceeded 4, an increased risk of stroke among patients whose ratios were 1.5-2 and a decreased risk of stroke at a ratio of 2.4. 4,5 However, the evidence supporting the range of 2-3 has some deficiencies. We sought to determine whether the risk of hemorrhagic and thromboembolic events is minimized at an international normalized ratio of 2-3 among patients taking anticoagulants. In addition, it has been observed that patients spend more time with a ratio below 2 than above 3.6,7 The impact of such systematic underanticoagulation on patient outcomes is unknown. We sought to determine the effect of under-or overanticoagulation on the risk of thromboemboli and hemorrhage. Methods Data sourcesWe searched MEDLINE (1966MEDLINE ( -2006 for potentially pertinent studies. We then modified our strategy to include EMBASE (1980EMBASE ( -2006, the Cochrane Central Register of Controlled Trials (1980Trials ( -2006 and CINAHL (1982CINAHL ( -2006 databases. We manually searched references in the Science Citation Index. Our search strategy is outlined in Appendix 1 (available at www.cmaj.ca/cgi/content/full/179/3/235/DC2). Study selection

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Section: Discussionmentioning

confidence: 99%

Anticoagulation intensity and outcomes among patients prescribed oral anticoagulant therapy: a systematic review and meta-analysis

Oake¹,

Jennings²,

Forster³

et al. 2008

Canadian Medical Association Journal

148

124

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“…63 Randomized trials have demonstrated that computer-assisted warfarin dosing results in better control of anticoagulant therapy than traditional dosing even by experienced medical staff. 74 Likewise, a multicomponent intervention that promotes patient education and participation in anticoagulant management provides better anticoagulation control than usual care. 75 Importantly, the multicomponent intervention halved the frequency of major bleeding during the first 6 months of anticoagulant therapy.…”

Section: Risk Of Bleeding During Anticoagulant Therapymentioning

confidence: 99%

Long-Term Management of Patients After Venous Thromboembolism

Kearon

2004

Circulation

112

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“…13,16 Many anticoagulation clinics already use computerized decision support systems, because these systems are effective in improving anticoagulation control. [17][18][19][20] However, even with the help of a computerized decision support system, monitoring patients is labour-intensive, because of the staff time required to call patients to communicate medication instructions. Additional staff time is needed to follow up with patients who forget to go for scheduled blood tests.…”

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confidence: 99%