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Predicting warfarin maintenance dosage based on initial response.

D R Miller, M A Brown

    American Journal of Hospital Pharmacy
    |October 1, 1979
    PubMed
    Summary
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    Determining warfarin maintenance dose is feasible. A correlation exists between the prothrombin ratio on day three and the required warfarin dose, aiding in dose adjustments for patients.

    Area of Science:

    • Pharmacology
    • Clinical Pharmacy

    Background:

    • Warfarin sodium is a widely used anticoagulant.
    • Establishing the correct maintenance dose is crucial for therapeutic efficacy and patient safety.
    • Prothrombin time (PT) and prothrombin ratio (PR) are key indicators of warfarin's anticoagulant effect.

    Purpose of the Study:

    • To investigate the relationship between initial response to warfarin sodium and its maintenance dose.
    • To explore predictors of warfarin maintenance dosage requirements.
    • To assess the feasibility of a simplified approach to warfarin dose determination.

    Main Methods:

    • A prospective study involving 22 hospital patients receiving warfarin sodium.
    • Initial daily dose of 10 mg warfarin sodium was administered until a target prothrombin ratio (PR) of 1.5-2.5 was achieved.

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  • Patients were subsequently maintained on the dosage that sustained the target PR.

    • Main Results:

    • A significant negative correlation (p < 0.01, r = -0.74) was observed between warfarin maintenance dose and the logarithm of the prothrombin ratio on day three.
    • No correlation was found between maintenance dose and the time required to reach a therapeutic response.
    • Patients with baseline PR < 1 required significantly longer to achieve therapeutic response compared to those with baseline PR > 1 (p < 0.01).

    Conclusions:

    • A correlation between early prothrombin ratio and warfarin maintenance dose suggests a potential for predicting dosage needs.
    • Baseline prothrombin ratio influences the time to achieve therapeutic anticoagulation.
    • Further validation is necessary before applying this correlation for routine warfarin dose determination.