Abstract
The aim of this prospective comparative evaluation of computer programs for the management of warfarin was to evaluate the effectiveness of three computerized systems currently used for assisting in warfarin control in outpatients compared with the customary dosing method used by experienced medical staff. Subjects were randomized to one of four groups: customary dosing by experienced medical staff unaware they were being monitored and three computerized warfarin dosage systems. A pilot randomized study of the three systems, with a follow-up independently randomized study of two of these, was made on 186 patients receiving long-term warfarin treatment or who had recently started warfarin treatment and had been discharged from the hospital. All three computerized systems seemed to give satisfactory control compared with the traditional dosing method. For patients receiving more intensive treatment with an assigned target range of INR 3.0–4.5, computerized dosage programs achieved significantly better control. The experienced medical staff undertreated such patients almost half of the time. We conclude from this prospective comparative study that computer-based programs may assist outpatient anticoagulant control with warfarin during both early and long-term treatment. For most patients, the control achieved is as good as that obtained by the customary method of dosing by experienced clinic physicians, although the latter tend to be too conservative when dosing patients within the more intense target range (INR 3.0–4.5).
Published Version
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