Abstract P199: Randomized Comparison of the DAWN AC Computer Program and a Simple Manual Nomogram for Quality of Warfarin Dosing
Bibliographic record
Abstract
Background In patients receiving warfarin, the quality of anticoagulant control as measured by the time-in-therapeutic range (TTR) for the International Normalized Ratio (INR) is a key determinant of risk for thromboembolic and bleeding events. Computer programs can assist physicians in optimizing TTR, but are expensive. The purpose of this study was to determine whether a computer system (DAWN AC) was non-inferior to a two-step manual nomogram used in a hospital anticoagulation clinic. Methods Stable anticoagulated patients receiving warfarin with target INR range 2-3 in the anticoagulation clinic were randomized to management with the newly acquired DAWN AC computer system or the clinic's standard of care, a simple manual dosing nomogram. After an initial run-in phase, study data collection started on February 1 st 2010 and was completed on August 8 th 2010. Primary outcome was the mean TTR calculated by the Rosendaal linear interpolation method. The non-inferiority margin was set at 4.5% lower TTR for DAWN AC compared with the nomogram. Results Of the 1,298 patients initially randomized, 1,127 were still managed by the clinic after the run-in phase and entered the study on February 1 st ; 564 were managed with DAWN AC, and 563 with the manual nomogram. The mean age of study patients was 69 ± 14 years and 62% were male. Main indications for anticoagulation were atrial fibrillation (48%) and prosthetic heart valves (25%). Mean follow-up was 172 days, encompassing 8,344 INR values and 155,041 patient days. Adherence to recommended warfarin doses was higher in the DAWN AC than in the nomogram group (99 vs. 90%; p<0.0001), the average interval between INR measurements was similar in the two groups (21 ± 12 vs. 21 ± 13 days; p=0.1987). In the primary analysis, mean TTR in the DAWN AC group was non-inferior to mean TTR in the nomogram group (71.0% ± 23.3 vs. 71.9% ± 22.9; non-inferiority p=0.0052). Conclusion Among stable patients receiving warfarin with a target INR of 2-3 in an anticoagulation clinic, quality of anticoagulant control with the DAWN AC computer program was non-inferior to a simple two-step manual dosing nomogram. The nomogram could be a useful dosing tool for physicians without access to a computerized warfarin dosing system.
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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 | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
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".