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摘要
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). %26lt;br%26gt;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 (INRs) and the incidence of excessive anticoagulation were compared in the AW-WIN and PDWD groups. %26lt;br%26gt;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 %26gt;= 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, 1.262.45; P = 0.001). The time-to-therapeutic INR %26gt;= 1.7 was shorter (P = 0.0002), the proportion of patients with therapeutic INR (23) at 5 days was higher (P = 0.002), and the rate of excessive anticoagulation of %26gt;= 3.5 INR during hospitalization was lower (P = 0.024) in the AW-WIN than in the PDWD group. %26lt;br%26gt;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.
- 出版日期2012-12
