Prescribing guidance pocket chart on the initiation of warfarin therapy in a geriatric hospital: a useful but challenging tool

• Published in: Annales de biologie clinique (Paris) Vol. 64; no. 3; p. 245
• Main Authors: Siguret, V, N'Guyen, A, Harboun, M, Chevallier, A, Pautas, E, Gouin-Thibault, I, Berigaud, S
• Format: Journal Article
• Language: French
• Published: France 01.05.2006
• Subjects: Aged, 80 and over; Anticoagulants - therapeutic use; Drug Prescriptions - standards; Female; Geriatrics; Guideline Adherence; Hospitals, Special; Humans; Male; Warfarin - therapeutic use
• ISSN: 0003-3898

Elderly patients are at high risk of over-anticoagulation and of haemorrhagic risk when on warfarin, especially during treatment induction. In Charles Foix Hospital, a 800-bed geriatric hospital, we specifically developed for in-patients older than 70 years (target INR 2.5) a simple low-dose warfarin induction regimen. The dosing recommendations were summarized on a prescribing guidance pocket chart. Eighteen months after the distribution of the chart, we conducted a one-year observational study in order to evaluate: i/ the time needed to achieve the warfarin maintenance dose; ii/ the prescriber'adherence to the recommendations; iii/ the benefit for elderly patients receiving warfarin therapy. The mean time needed to achieve the warfarin maintenance dose was 12.3 +/- 7.0 days for the 89 patients included in the study: 10.6 +/- 5.9 days for the 30 patients whose prescribers followed the recommendations versus 13.5 +/- 7.6 days for the 59 patients whose prescribers did not follow the recommendations. There is a trend to a more frequent over-anticoagulation in patients whose prescribers did not follow the recommendations. The duration of the heparin-warfarin overlap was significantly shorter when the recommendations were followed. Finally, the reasons for non-adherence to the recommendations were analyzed. This study illustrates an assessment of practice in an health care institution.