A 10-mg nomogram was more effective than a 5-mg nomogram for warfarin induction in outpatient venous thromboembolism: COMMENTARY

Beyth, Rebecca J.
November 2003
ACP Journal Club;Nov/Dec2003, Vol. 139 Issue 3, p59
Academic Journal
Venous thromboembolism(VTE) is a common and potentially fatal disease that annually affects 2 persons per 1000. Although advances in diagnostics and treatment have been made, much more work is needed to lessen the burden of this chronic disease. Newer therapies, such as low molecular weight heparin, have shifted treatment of acute VTE to the outpatient setting where maximizing the efficiency and safety of warfarin loading could reduce the time needed to achieve a therapeutic international normalized ratio (INR). This could potentially be translated into cost savings if the overlap of heparin and warfarin therapies and the frequency of INR testing were minimized. Patients who require inpatient treatment are clinically different, and this nomogram may not be appropriate for them or other patients who require a lower loading dose. The trials main strength was the 90-day follow-up, although the study was not powered to detect significant differences in the outcomes of recurrent VTE, major bleeding, or death.


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