Dalere G M, Coleman R W, Lum B L
Department of Pharmacy, Kaiser Permanente Medical Center, Santa Clara, California, USA.
Pharmacotherapy. 1999 Apr;19(4):461-7. doi: 10.1592/phco.19.6.461.31038.
We assessed the ability of a graphic nomogram to adjust steady-state warfarin dosages and to predict international normalized ratios (INR) after a dosage change, compared with an anticoagulation clinic pharmacist and a Bayesian regression computer program. Study subjects were 108 men and 3 women receiving warfarin anticoagulation. In all patients the median absolute errors in predicted INR values for the nomogram, computer program, and pharmacist were 0.33, 0.46, and 0.48, respectively. The nomogram was significantly more precise than both other methods (p=0.036). In a subset of 50 patients who required dosage reductions, the median absolute INR prediction errors for the nomogram, computer program, and pharmacist were 0.35, 0.54, and 0.48 respectively. The nomogram was significantly more precise than the pharmacist (p=0.005) and computer (p=0.002). The ability to provide more precise dosage reductions of warfarin may be of clinical importance in light of current recommendations for higher-intensity warfarin therapy and maintenance of higher INR values. Prospective validation of the performance of this nomogram in a routine clinical setting is warranted.
我们评估了一种图形化列线图调整华法林稳态剂量以及预测剂量改变后国际标准化比值（INR）的能力，并与抗凝门诊药师和贝叶斯回归计算机程序进行了比较。研究对象为108名接受华法林抗凝治疗的男性和3名女性。在所有患者中，列线图、计算机程序和药师预测INR值的中位绝对误差分别为0.33、0.46和0.48。列线图比其他两种方法都显著更精确（p = 0.036）。在需要降低剂量的50名患者亚组中，列线图、计算机程序和药师预测INR的中位绝对误差分别为0.35、0.54和0.48。列线图比药师（p = 0.005）和计算机（p = 0.002）都显著更精确。鉴于当前关于高强度华法林治疗和维持较高INR值的建议，能够更精确地降低华法林剂量可能具有临床重要性。有必要在常规临床环境中对该列线图的性能进行前瞻性验证。
