AI-WAR: a novel warfarin management software with a bidirectional LSTM dosing model improves time in therapeutic...

Area of Science:

• Cardiovascular Medicine
• Artificial Intelligence in Healthcare
• Pharmacogenomics and Precision Medicine

Background:

• Warfarin is a critical anticoagulant for heart valve replacement patients but poses management challenges due to its narrow therapeutic window and monitoring needs.
• Suboptimal anticoagulation quality is common in real-world settings, especially in resource-limited primary care.
• Interindividual variability and frequent INR monitoring complicate effective warfarin management.

Purpose of the Study:

• To develop and validate an artificial intelligence-based warfarin management system (AI-WAR) for improved anticoagulation.
• To assess the efficacy of AI-WAR in enhancing anticoagulation quality and reducing adverse events compared to conventional methods.
• To evaluate the predictive performance of LSTM and Bi-LSTM models for individualized warfarin dosing.

Main Methods:

• Developed an AI-WAR system integrating remote follow-up, data management, and individualized dosing prediction models.
• Trained models using data from a randomized controlled trial (n=624) and a prospective registry (n=176).
• Validated the system on an independent real-world cohort (n=200) and compared outcomes with conventional management.

Main Results:

• AI-WAR significantly improved median time in therapeutic range (TTR) from 48.7% to 81.3% (P < 0.001).
• AI-WAR increased time in target INR (36.3% vs. 61.9%, P < 0.001) and reduced adverse events (9.6% vs. 19.7%, P < 0.001).
• The Bi-LSTM model demonstrated superior dose prediction accuracy (80.3%) and stable dose prediction (93.2%), reducing overdose predictions.

Conclusions:

• AI-WAR, coupled with Bi-LSTM models, serves as an effective decision-support tool for precision warfarin dosing.
• The system enhances anticoagulation quality, minimizes adverse events, and offers practical benefits for remote and primary care settings.
• AI-WAR supports the broader implementation of precision anticoagulation therapy, improving patient outcomes.