Dosing Options for Decreasing the Time to Achieve Therapeutic Anticoagulation When Reinitiating Warfarin: A Case Series
Bibliographic record
Abstract
STUDY OBJECTIVES: To determine dosing options for decreasing the time to achieve a therapeutic international normalized ratio (INR) threshold of 2.0 when restarting warfarin in an ambulatory population whose previous warfarin maintenance doses are known, and to identify thromboembolic and major bleeding events up to 90 days after disruption of warfarin therapy. DESIGN: Retrospective medical record review. SETTING: Ambulatory anticoagulation management service (AMS) in Canada. PATIENTS: Thirty-six patients managed by the AMS whose warfarin doses were withheld for a minimum of 4 consecutive days, who did not use vitamin K for warfarin reversal, and who had at least 90 days of follow-up after restarting warfarin between January 1, 2005, and April 1, 2010. MEASUREMENTS AND MAIN RESULTS: Forty-one episodes of warfarin reinitiation in the 36 patients were identified. Time to therapeutic INR was defined as days to reach a therapeutic INR threshold of 2.0, regardless of usual target INR or indication for warfarin therapy. Restarting warfarin at previous maintenance doses (i.e., no loading dose) took a median of 20.5 days (interquartile range [IQR] 14.3-31.3 days) to achieve a therapeutic INR. In contrast, administering a loading dose approximating 40% more than the previous daily maintenance dose for 2 or 3 days, on either the first day or after the first day of warfarin reinitiation, shortened the time to achieve a therapeutic INR to a median of 5.0 days (IQR 4.0-6.0 days) or 6.0 days (IQR 5.0-7.8 days), respectively. No thromboembolic events occurred during the 90-day follow-up period. Six episodes of major bleeding occurred. All occurred in patients who received a warfarin loading dose; however, most had INRs less than 2.0 and had risk factors for bleeding. CONCLUSION: In select patients, the option of administering a warfarin loading dose of approximately 40% greater than the previous daily maintenance dose for 2 or 3 days shortens the time to achieving therapeutic anticoagulation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.012 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.004 | 0.002 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".