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Age‐ and weight‐adjusted warfarin initiation nomogram for ischaemic stroke patients
Author(s) -
Yoo S.H.,
Kwon S. U.,
Jo M.W.,
Kang D.W.,
Kim J. S.
Publication year - 2012
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/j.1468-1331.2012.03772.x
Subject(s) - medicine , nomogram , ischaemic stroke , warfarin , stroke (engine) , cardiology , ischemia , atrial fibrillation , mechanical engineering , engineering
Objectives Specific guidelines for initial dosing of warfarin in ischaemic stroke patients have not been developed. Therefore, we have developed an age‐ and weight‐adjusted warfarin initiation nomogram ( AW ‐ WIN ) for ischaemic stroke patients and then evaluated the efficacy and safety of AW ‐ WIN compared with physician‐determined warfarin dosing ( PDWD ). Methods The age‐ and weight‐adjusted warfarin initiation nomogram was administered to 104 acute ischaemic stroke patients between January 2008 and February 2009. A historical control group ( PDWD ) of 96 patients was selected from comparable patients who were discharged with warfarin during the previous year. Time‐to‐therapeutic international normalized ratios ( INR s) and the incidence of excessive anticoagulation were compared in the AW ‐ WIN and PDWD groups. Results The general characteristics, risk factors, and stroke mechanism of the AW ‐ WIN and PDWD groups did not differ significantly. The mean time to INR ≥ 2.0 was significantly shorter in the AW ‐ WIN than in the PDWD group (4.9 ± 0.7 vs. 6.2 ± 0.8 days, P = 0.0008). After adjustment for potential confounding variables, the AW ‐ WIN group reached target INR faster than the PDWD group (hazard ratio, 1.76; 95% confidence interval, 1.26–2.45; P = 0.001). The time‐to‐therapeutic INR ≥1.7 was shorter ( P = 0.0002), the proportion of patients with therapeutic INR (2–3) at 5 days was higher ( P = 0.002), and the rate of excessive anticoagulation of ≥3.5 INR during hospitalization was lower ( P = 0.024) in the AW ‐ WIN than in the PDWD group. Conclusions AW ‐ WIN reduces the time to target INR and the risk of excessive anticoagulation. AW ‐ WIN may be an efficient and safe method of anticoagulation during the acute phase of ischaemic stroke.