Age and Ageing, Vol 29, 31-34, Copyright © 2000 by British Geriatrics Society
J Gedge, S Orme, KK Hampton, KS Channer and TJ Hendra
OBJECTIVES: To compare a new low-dose warfarin induction regimen with the
Fennerty regimen in elderly inpatients. DESIGN: Age-stratified, randomized
prospective study. SUBJECTS: 120 age-stratified elderly inpatients.
INTERVENTIONS: Each patient was randomized to either the new induction
regimen or to a modified Fennerty regimen. MAIN OUTCOMES MEASURES: Days to
therapeutic International Normalized Ratio (INR >2); days in the
therapeutic range (INR 2-3) during induction; number of patients with INR
>4.5; ability of day 4 INR to predict day 8 warfarin dose. RESULTS: The
mean time to therapeutic INR was longer for the new induction regimen than
modified Fennerty regimen in patients aged 65-75 years [4.6 (mean) +/- 1.6
(SD) days vs 3.8 +/- 0.8 days; P = 0.03] and in patients aged >75 years
(4.5 +/- 1.4 days vs 3.5 +/- 0.7 days; P = 0.003). Patients spent more time
in the therapeutic INR range with the new induction regimen [3.0 +/- 1.3
days vs 2.7 +/- 1.3 days (P = 0.03) for those aged 65-75 years and 2.9 +/-
1.1 days vs 2.4 +/- 1.3 days (P = 0.04 for those aged >75 years]. Fewer
patients using the new regimen had INRs >4.5 in the first 8 days [1 (3%)
vs 6 (20%) for 65-75 years (P < 0.05) and 1 (3%) vs 11 (37%) for >75
years (P < 0.01)]. The ability to predict the maintenance dose to within
1 mg was 55% for both regimens. CONCLUSION: The low-dose regimen has
important clinical advantages over the Fennerty regimen for anticoagulating
elderly inpatients.
ARTICLES
A comparison of a low-dose warfarin induction regimen with the modified Fennerty regimen in elderly inpatients
Department of Geriatric Medicine, Royal Hallamshire Hospital, Sheffield, UK.
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