Implications of an inpatient warfarin dosing nomogram on safety outcomes post-discharge

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dc.contributor.author Chamoun, Nibal
dc.contributor.author Macias, C. Gabriela
dc.contributor.author Donovan, Jennifer L.
dc.contributor.author Klugman, Robert
dc.contributor.author Gore, Joel
dc.contributor.author Salameh, Pascale
dc.contributor.author Tran, Maichi T.
dc.date.accessioned 2017-12-19T08:31:59Z
dc.date.available 2017-12-19T08:31:59Z
dc.date.copyright 2017 en_US
dc.date.issued 2017-12-19
dc.identifier.issn 1573-742X en_US
dc.identifier.uri http://hdl.handle.net/10725/6834
dc.description.abstract Many hospitals have implemented warfarin dosing nomograms to improve patient safety. To our knowledge, no study has assessed the impact inpatient warfarin initiation has in both medical and surgical patients, on safety outcomes post discharge. To evaluate the impact of a suggested institutional nomogram for the initiation of warfarin, the primary endpoint was the incidence of bleeding throughout follow up. Secondary endpoints included the composite of INR changes ≥0.5/day and INR >4. Patients were followed for a period of 2 weeks post-discharge. The composite endpoint was evaluated for an effect on reaching therapeutic INR, time to reach therapeutic INR, and bleeding events throughout follow up. A single center retrospective study comparing the safety of adherence vs. non-adherence to a warfarin nomogram. A total of 206 patients were included, 73 patients in the nomogram adherence vs. 133 in the nonadherence arm. There was no difference in the proportion of patients who bled throughout the follow up period, adherence 9.6% vs. nonadherence to the nomogram 13.5%, p = 0.407. There was however a statistical difference in the mean total number of bleeding events, 0.096 (7/73) in the adherence vs. 0.158 (21/133) in the non-adherence arm, p = 0.022. There was also no difference in the composite endpoint, 19.2% in the adherence vs. 28.6% in the non-adherence arm p = 0.180. A positive correlation between the inpatient composite and risk of bleeding throughout follow up was noted. The findings of this study support adherence to the nomogram as opposed to non-adherence. en_US
dc.language.iso en en_US
dc.title Implications of an inpatient warfarin dosing nomogram on safety outcomes post-discharge en_US
dc.type Article en_US
dc.description.version Published en_US
dc.author.school SOP en_US
dc.author.idnumber 200201071 en_US
dc.author.department Pharmacy Practice en_US
dc.description.embargo N/A en_US
dc.relation.journal Journal of Thrombosis and Thrombolysis en_US
dc.journal.volume 43 en_US
dc.journal.issue 4 en_US
dc.article.pages 454-462 en_US
dc.keywords Warfarin en_US
dc.keywords Anticoagulation en_US
dc.keywords Nomograms en_US
dc.keywords Inpatient en_US
dc.keywords Safety en_US
dc.identifier.doi https://doi.org/10.1007/s11239-016-1462-0
dc.identifier.ctation Chamoun, N., Macías, C. G., Donovan, J. L., Klugman, R., Gore, J., Salameh, P., & Tran, M. T. (2017). Implications of an inpatient warfarin dosing nomogram on safety outcomes post-discharge. Journal of Thrombosis and Thrombolysis, 43(4), 454-462. en_US
dc.author.email nibal.chamoun@lau.edu.lb en_US
dc.identifier.tou http://libraries.lau.edu.lb/research/laur/terms-of-use/articles.php en_US
dc.identifier.url https://link.springer.com/article/10.1007/s11239-016-1462-0 en_US
dc.orcid.id https://orcid.org/0000-0002-0987-296X
dc.author.affiliation Lebanese American University en_US

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