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Warfarin Dosing Algorithms Underpredict Dose Requirements in Patients Requiring ≥7 mg Daily: A Systematic Review and Meta‐analysis
Author(s) -
Saffian SM,
Duffull SB,
Wright DFB
Publication year - 2017
Publication title -
clinical pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.941
H-Index - 188
eISSN - 1532-6535
pISSN - 0009-9236
DOI - 10.1002/cpt.649
Subject(s) - dosing , meta analysis , warfarin , medicine , pharmacology , atrial fibrillation
There is preliminary evidence to suggest that some published warfarin dosing algorithms produce biased maintenance dose predictions in patients who require higher than average doses. We conducted a meta‐analysis of warfarin dosing algorithms to determine if there exists a systematic under‐ or overprediction of dose requirements for patients requiring ≥7 mg/day across published algorithms. Medline and Embase databases were searched up to September 2015. We quantified the proportion of over‐ and underpredicted doses in patients whose observed maintenance dose was ≥7 mg/day. The meta‐analysis included 47 evaluations of 22 different warfarin dosing algorithms from 16 studies. The meta‐analysis included data from 1,492 patients who required warfarin doses of ≥7 mg/day. All 22 algorithms were found to underpredict warfarin dosing requirements in patients who required ≥7 mg/day by an average of 2.3 mg/day with a pooled estimate of underpredicted doses of 92.3% (95% confidence interval 90.3–94.1, I 2 = 24%).