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

Somayyeh Barati; Mohammad Mehdi Mohammadpour; Mohammad Ali Sadrameli; Saeed Hosseini; Majid Maleki; Reza Golpira; Hooman Bakhshandeh; Majid Kyavar; Jamal Moosavi; Bahram Mohebbi; Azita H Talasaz; Stefano Barco; Frederikus A Klok; Parham Sadeghipour

doi:10.1097/HPC.0000000000000357

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

Crit Pathw Cardiol. 2024 Mar 27. doi: 10.1097/HPC.0000000000000357. Online ahead of print.

Authors

Affiliations

¹ Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
² School of Technology, SRH Berlin University of Applied Science, Berlin, Germany.
³ Heart Valve Diseases Research Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran.
⁴ Tehran Heart Center, Tehran University of Medical Sciences, Tehran Iran.
⁵ Department of Angiology, University Hospital Zurich, Zurich, Switzerland.
⁶ Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Mainz, Germany.
⁷ Department of Medicine-Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, Netherlands.

PMID: 38578971
DOI: 10.1097/HPC.0000000000000357

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 (TTR) 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 TTR was 57.3% before and 59% after WMS implementation (mean difference, 1.64, 95% CI: -1.12 to 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.