A Multicomponent Intervention To Prevent Major Bleeding Complications in Older Patients Receiving Warfarin

摘要: Background: Warfarin is effective in the treatment and prevention of many venous thromboembolic disorders, but it often leads to bleeding. Objective: To develop a multicomponent program management warfarin therapy determine its effect on frequency warfarin-related major bleeding older patients. Design: Randomized, controlled trial. Setting: University hospital Cleveland, Ohio. Patients: 325 patients 65 years age or who started during hospitalization. Interventions: Patients were stratified according baseline risk for randomly assigned receive intervention (n = 163) usual care 162) by their primary physicians 6 months. The consisted patient education about warfarin, training increase participation, self-monitoring prothrombin time, guideline-based dosing. Measurements: Major bleeding, death, recurrent thromboembolism, therapeutic control anticoagulant at Results: In an intention-to-treat analysis, was more common months group than (cumulative incidence, 12% vs. 5.6%; P= 0.0498, log-rank test). most frequent site both groups gastrointestinal tract. Death thromboembolism occurred with similar Throughout months, proportion total time which international normalized ratio within range higher (56% 32%; P < 0.001). After frequencies groups. Conclusions: A comprehensive reduced Although generalizability cost-effectiveness this remain be demonstrated, these findings support premise that efforts reduce likelihood will lead safe use