Robert J. DiDomenico, PharmD
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DiDomenico R.; Randomized Trial of Warfarin Nomograms. Ann Intern Med. 2004;140:489-490. doi: 10.7326/0003-4819-140-6-200403160-00026
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Published: Ann Intern Med. 2004;140(6):489-490.
TO THE EDITOR:
The debate rages on! Does “loading” patients with warfarin achieve the therapeutic goal more quickly than starting with a lower dose that approximates a typical maintenance dose? Previous studies suggested that starting with a lower daily dose (5 mg) rather than a loading dose (10 mg) allows more patients to achieve the target INR of 2.0 to 3.0 while avoiding the excessive anticoagulation (INR > 3.0) commonly seen with warfarin loading doses (1, 2). The American College of Chest Physicians recommends starting with an average daily maintenance dose of 5 mg (3). However, Kovacs and colleagues (4) demonstrated that 10-mg warfarin initiation achieved the target INR 1.4 days sooner than the 5-mg dose without causing excessive anticoagulation in the first 4 weeks of therapy. The results of this well-designed study fuel this debate, particularly since it is the largest comparison published to date (1, 2, 4).
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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