Related Experiment Video

Updated: Jun 2, 2026

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
23:33

The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation

Published on: February 28, 2012

Management of warfarin in children with heart disease

William T Mahle1, Scott A Simpson, Paulette Fye

  • 1Children's Healthcare of Atlanta, Emory University School of Medicine, 1405 Clifton Rd. NE, Atlanta, GA 30322, USA. mahlew@kidsheart.com

Pediatric Cardiology
|April 19, 2011
PubMed

Insights

Computerized warfarin dosing software improved INR control in pediatric cardiac patients, increasing time within the target range. Further strategies are needed to address sex and racial disparities in warfarin management.

Area of Science:

  • Pediatric Cardiology
  • Pharmacogenomics and Drug Dosing
  • Medical Informatics

Background:

  • Warfarin is crucial for pediatric cardiac patients, but achieving therapeutic International Normalized Ratio (INR) ranges can be challenging.
  • Current warfarin management relies on physician judgment and established guidelines, with variable success in maintaining optimal INR levels.
  • Patient-related factors, including sex and race, have been associated with difficulties in achieving target INR control.

Purpose of the Study:

  • To evaluate the impact of a computerized warfarin-dosing software on INR control in pediatric cardiac patients.
  • To compare the percentage of time within the target INR range before and after the implementation of dosing software.
  • To identify patient-related factors associated with suboptimal INR control.

Main Methods:

  • A historical case-control study design was employed, analyzing data from pediatric patients (infant to 20 years) with cardiac disease on warfarin.
  • INR values and warfarin dosing adjustments were compared between a period before and after the introduction of computerized dosing software.
  • Statistical analyses were performed to assess the change in time within the target INR range and identify associated patient factors.

Main Results:

  • The study included 86 pediatric patients, with prosthetic valve being the most common indication for warfarin.
  • Overall incidence of adverse bleeding events was 1.3% per patient-year.
  • Implementation of the computerized dosing software significantly increased the percentage of time within the target INR range from 41.4% to 53.1% (P < 0.001).
  • Female sex and nonwhite race were significantly associated with less time within the target INR range (P = 0.048 and P = 0.037, respectively).

Conclusions:

  • Computerized warfarin-dosing software can significantly improve INR control in pediatric cardiac patients.
  • Despite software improvements, disparities in warfarin management based on sex and race persist.
  • Further research and targeted strategies are necessary to optimize warfarin therapy and reduce inequities in this vulnerable population.

More Related Videos

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

Related Concept Videos

Venous Thrombosis III: Interprofessional Care01:29

Venous Thrombosis III: Interprofessional Care

Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants01:18

Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants

Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Drug Dosing: Infants and Children01:29

Drug Dosing: Infants and Children

Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
Venous Thrombosis IV: Nursing Management01:30

Venous Thrombosis IV: Nursing Management

Nursing management begins with a thorough assessment of the patient's health history. Key factors include trauma to veins, peripherally inserted central catheters, varicose veins, recent pregnancy or childbirth, surgery, bacteremia, prolonged bed rest, atrial fibrillation, COPD, heart failure, cancer, coagulation disorders, myocardial infarction, spinal cord injury, stroke, prolonged travel, recent bone fractures, and dehydration. Review medication intake, particularly oral contraceptives,...
Rheumatic Heart Disease IV: Nursing Management01:20

Rheumatic Heart Disease IV: Nursing Management

AssessmentA comprehensive assessment is essential in managing a patient with rheumatic heart disease (RHD). Begin with obtaining a detailed medical history, including recent streptococcal infections, a history of rheumatic fever, or previously diagnosed rheumatic heart disease. Assess the patient for symptoms such as fever, chest pain, widespread joint pain (arthralgia), tachycardia, pericardial friction rub, muffled heart sounds, heart murmurs, peripheral edema, subcutaneous nodules, and...