Applying a Computer-based Warfarin Management System at a Large Tertiary Cardiovascular Center in Iran

Critical Pathways in Cardiology A Journal of Evidence-Based Medicine, vol. 23, pp. 124–130

Abstract

BACKGROUND: Regarding adjustments to warfarin dosage, numerous studies have shown that computerized methods are superior to those based on personal experience. OBJECTIVES: To report the efficacy of a computer-based warfarin management system (WMS) in the Iranian population. METHODS: By utilizing the existing dosing algorithms and obtaining expert opinions, we developed a computer-based WMS at a large tertiary cardiovascular center. The time in therapeutic range and the number of international normalized ratio (INR) tests of clinic patients were compared before and after the implementation of WMS. RESULTS: Overall, 803 patients with 5407 INR tests were included in the before phase and 679 patients with 4189 INR tests in the after phase. The mean time in therapeutic range was 57.3% before and 59% after WMS implementation [mean difference, 1.64; 95% confidence interval (CI), -1.12-4.40]. In the before phase, the mean number of INR tests was 6.7, which dropped to 6.1 tests in the after phase (mean difference, -0.61; 95% CI, -0.97 to -0.24). Only 54.5% of the warfarin dosing prescriptions were consistent with the dosing recommendations of the WMS, and adherence to the WMS was poorest in the highest INR target range. CONCLUSIONS: For the first time in Iran, we demonstrated that a computerized system was as effective as a traditional experience-based method to monitor INR in VKA-anticoagulated patients. Furthermore, it could reduce both the number of INR tests and that of visits.

Authors 14

1. Somayyeh Barati corresponding

   Iran University of Medical Sciences

   Affiliation as printed

   From the Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

2. Mohammad Mehdi Mohammadpour

   SRH University Berlin

   Affiliation as printed

   School of Technology, SRH Berlin University of Applied Science, Berlin, Germany

3. Mohammad Ali Sadr‐Ameli corresponding

   Iran University of Medical Sciences

   Affiliation as printed

   From the Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

4. Saeid Hosseini

   Iran University of Medical Sciences · Shaheed Rajaei Cardiovascular Medical and Research Center

   Affiliation as printed

   Heart Valve Diseases Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran

5. Majid Maleki corresponding

   Iran University of Medical Sciences

   Affiliation as printed

   From the Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

6. Reza Golpira corresponding

   Iran University of Medical Sciences

   Affiliation as printed

   From the Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

7. Hooman Bakhshandeh corresponding

   Iran University of Medical Sciences

   Affiliation as printed

   From the Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

8. Majid Kyavar corresponding

   Iran University of Medical Sciences

   Affiliation as printed

   From the Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

9. Jamal Moosavi corresponding

   Iran University of Medical Sciences

   Affiliation as printed

   From the Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

10. Bahram Mohebbi corresponding

    Iran University of Medical Sciences

    Affiliation as printed

    From the Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

11. Azita H. Talasaz

    Tehran Heart Center · Tehran University of Medical Sciences

    Affiliation as printed

    Tehran Heart Center, Tehran University of Medical Sciences, Tehran Iran

12. Stefano Barco

    Johannes Gutenberg University Mainz · University Hospital Zurich

    Affiliation as printed

    Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany

    Department of Angiology, University Hospital Zurich, Zurich, Switzerland

13. Frederikus Albertus Klok corresponding Aachen Dept of Medicine - Thrombosis and Hemostasis

    Johannes Gutenberg University Mainz · Leiden University Medical Center

    Affiliation as printed

    Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany

    Department of Medicine-Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands

14. Parham Sadeghipour corresponding

    Iran University of Medical Sciences

    Affiliation as printed

    From the Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran