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Age and body weight adjusted warfarin initiation program for ischaemic stroke patients
- Source :
- European Journal of Neurology. 16:1100-1105
- Publication Year :
- 2009
- Publisher :
- Wiley, 2009.
-
Abstract
- Despite its proven effect, anticoagulation is not recommended to the acute ischaemic stroke due to the risk of bleeding complications. The purpose of this study is development of individualized warfarin initiation program for acute or subacute stroke patients.Among stroke patients who regularly visited out-patient clinics, we included patients who have continuously taken the same dose of warfarin as the prothrombin time remained at target International Nomarlized Ratio (INR). We assessed potential variables that affect the maintenance dose of warfarin. Using these variables, we developed an individualized warfarin initiation program.The median warfarin maintenance dose (interquartile range) in the 321 included patients was 4 (3-5) mg per day. Age (adjusted R(2) = 0.221, P0.001) and body weight (added to age, adjusted R(2) = 0.238, P = 0.008) were significant predicting factors of the dose. We classified the maintenance doses into high (HG), standard, and low group (LG) based on the distribution of maintenance doses. Decision tree analysis categorized younger (or=55 years old) and heavier (or=55 kg) patients into HG, and very old (or=80 years old) or low body weight (55 kg among those56 years old) patients into LG. We recommend 7 mg of warfarin as a standard initial dose, but 10 mg was recommended for HG patients and 5 mg for LG.We expect that this individualized program may reduce the time to target INR without excessive anticoagulation. Further prospective studies are needed to reveal the efficacy and safety of applying this program for acute stroke patients.
- Subjects :
- Male
medicine.medical_specialty
Initial dose
Body weight
Drug Administration Schedule
Body Mass Index
Interquartile range
Internal medicine
Ischaemic stroke
Secondary Prevention
medicine
Humans
International Normalized Ratio
cardiovascular diseases
Prospective cohort study
Aged
Prothrombin time
medicine.diagnostic_test
Maintenance dose
business.industry
Patient Selection
Age Factors
Warfarin
Anticoagulants
Thrombosis
Middle Aged
Surgery
Stroke
Treatment Outcome
Neurology
Female
Neurology (clinical)
business
medicine.drug
Subjects
Details
- ISSN :
- 14681331 and 13515101
- Volume :
- 16
- Database :
- OpenAIRE
- Journal :
- European Journal of Neurology
- Accession number :
- edsair.doi.dedup.....00ea1803cc3c14ecc3890d72b31309f5