An international multicenter randomized study of computer-assisted oral anticoagulant dosage vs. medical staff dosage

L Poller; M Keown; S Ibrahim; G Lowe; M Moia; AG Turpie; C Roberts; AMHP Van den Besselaar; FJM Van der Meer; A Tripodi; G Palareti; C Shiach; Stirling Bryan; M Samama; M Burgess-Wilson; A Heagerty; P Maccallum; D Wright; J Jespersen

doi:10.1111/j.1538-7836.2008.02959.x

An international multicenter randomized study of computer-assisted oral anticoagulant dosage vs. medical staff dosage

L Poller, M Keown, S Ibrahim, G Lowe, M Moia, AG Turpie, C Roberts, AMHP Van den Besselaar, FJM Van der Meer, A Tripodi, G Palareti, C Shiach, Stirling Bryan, M Samama, M Burgess-Wilson, A Heagerty, P Maccallum, D Wright, J Jespersen

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Abstract

Background: Increased demand for oral anticoagulants is overwhelming facilities worldwide, resulting in increasing use of computer assistance. A multicenter clinical endpoint study has been performed to compare the safety and effectiveness of computer-assisted dosage with dosage by experienced medical staff at the same centers. Methods: A randomized study of dosage of two commercial computer-assisted dosage programs (PARMA 5 and DAWN AC) vs. manual dosage at 32 centers with an established interest in oral anticoagulation in 13 countries. The aim was to recruit a minimum of 16 000 patient-years randomized to medical staff or computer-assisted dosage. In total, 13 219 patients participated, 6503 patients being randomized to medical staff and 6716 to computer-assisted dosage. The safety and effectiveness of computer-assisted dosage were compared with those of medical staff dosage. Results: In total, 13 052 patients were recruited (18 617 patient-years). International Normalized Ratio (INR) tests numbered 193 890 with manual dosage and 193 424 with computer-assisted dosage. The number of clinical events with computer-assisted dosage was lower (P = 0.1), but in the 3209 patients with deep vein thrombosis/pulmonary embolism, they were reduced by 37 (24%, P = 0.001). Time in target INR range was significantly improved by computer assistance as compared with medical staff dosage at the majority of centers (P <0.001). Conclusions: The safety and effectiveness of computer-assisted dosage has been demonstrated using two different marketed programs in comparison with experienced medical staff dosage at the centers with established interest in anticoagulation. Significant prevention of clinical events in patients with deep vein thrombosis/pulmonary embolism and the achievement of target INR in all clinical groups has been observed. The reliability and safety of other marketed computer-assisted dosage programs need to be established.

Original language	English
Pages (from-to)	935-943
Number of pages	9
Journal	Journal of Thrombosis and Haemostasis
Volume	6
Issue number	6
DOIs	https://doi.org/10.1111/j.1538-7836.2008.02959.x
Publication status	Published - 1 Jun 2008

Keywords

safety
effectiveness
INR
clinical events
computer-assisted dosage

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10.1111/j.1538-7836.2008.02959.x

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Poller, L., Keown, M., Ibrahim, S., Lowe, G., Moia, M., Turpie, AG., Roberts, C., Van den Besselaar, AMHP., Van der Meer, FJM., Tripodi, A., Palareti, G., Shiach, C., Bryan, S., Samama, M., Burgess-Wilson, M., Heagerty, A., Maccallum, P., Wright, D., & Jespersen, J. (2008). An international multicenter randomized study of computer-assisted oral anticoagulant dosage vs. medical staff dosage. Journal of Thrombosis and Haemostasis, 6(6), 935-943. https://doi.org/10.1111/j.1538-7836.2008.02959.x

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title = "An international multicenter randomized study of computer-assisted oral anticoagulant dosage vs. medical staff dosage",

abstract = "Background: Increased demand for oral anticoagulants is overwhelming facilities worldwide, resulting in increasing use of computer assistance. A multicenter clinical endpoint study has been performed to compare the safety and effectiveness of computer-assisted dosage with dosage by experienced medical staff at the same centers. Methods: A randomized study of dosage of two commercial computer-assisted dosage programs (PARMA 5 and DAWN AC) vs. manual dosage at 32 centers with an established interest in oral anticoagulation in 13 countries. The aim was to recruit a minimum of 16 000 patient-years randomized to medical staff or computer-assisted dosage. In total, 13 219 patients participated, 6503 patients being randomized to medical staff and 6716 to computer-assisted dosage. The safety and effectiveness of computer-assisted dosage were compared with those of medical staff dosage. Results: In total, 13 052 patients were recruited (18 617 patient-years). International Normalized Ratio (INR) tests numbered 193 890 with manual dosage and 193 424 with computer-assisted dosage. The number of clinical events with computer-assisted dosage was lower (P = 0.1), but in the 3209 patients with deep vein thrombosis/pulmonary embolism, they were reduced by 37 (24%, P = 0.001). Time in target INR range was significantly improved by computer assistance as compared with medical staff dosage at the majority of centers (P <0.001). Conclusions: The safety and effectiveness of computer-assisted dosage has been demonstrated using two different marketed programs in comparison with experienced medical staff dosage at the centers with established interest in anticoagulation. Significant prevention of clinical events in patients with deep vein thrombosis/pulmonary embolism and the achievement of target INR in all clinical groups has been observed. The reliability and safety of other marketed computer-assisted dosage programs need to be established.",

keywords = "safety, effectiveness, INR, clinical events, computer-assisted dosage",

author = "L Poller and M Keown and S Ibrahim and G Lowe and M Moia and AG Turpie and C Roberts and {Van den Besselaar}, AMHP and {Van der Meer}, FJM and A Tripodi and G Palareti and C Shiach and Stirling Bryan and M Samama and M Burgess-Wilson and A Heagerty and P Maccallum and D Wright and J Jespersen",

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Poller, L, Keown, M, Ibrahim, S, Lowe, G, Moia, M, Turpie, AG, Roberts, C, Van den Besselaar, AMHP, Van der Meer, FJM, Tripodi, A, Palareti, G, Shiach, C, Bryan, S, Samama, M, Burgess-Wilson, M, Heagerty, A, Maccallum, P, Wright, D & Jespersen, J 2008, 'An international multicenter randomized study of computer-assisted oral anticoagulant dosage vs. medical staff dosage', Journal of Thrombosis and Haemostasis, vol. 6, no. 6, pp. 935-943. https://doi.org/10.1111/j.1538-7836.2008.02959.x

TY - JOUR

T1 - An international multicenter randomized study of computer-assisted oral anticoagulant dosage vs. medical staff dosage

AU - Poller, L

AU - Keown, M

AU - Ibrahim, S

AU - Lowe, G

AU - Moia, M

AU - Turpie, AG

AU - Roberts, C

AU - Van den Besselaar, AMHP

AU - Van der Meer, FJM

AU - Tripodi, A

AU - Palareti, G

AU - Shiach, C

AU - Bryan, Stirling

AU - Samama, M

AU - Burgess-Wilson, M

AU - Heagerty, A

AU - Maccallum, P

AU - Wright, D

AU - Jespersen, J

PY - 2008/6/1

Y1 - 2008/6/1

N2 - Background: Increased demand for oral anticoagulants is overwhelming facilities worldwide, resulting in increasing use of computer assistance. A multicenter clinical endpoint study has been performed to compare the safety and effectiveness of computer-assisted dosage with dosage by experienced medical staff at the same centers. Methods: A randomized study of dosage of two commercial computer-assisted dosage programs (PARMA 5 and DAWN AC) vs. manual dosage at 32 centers with an established interest in oral anticoagulation in 13 countries. The aim was to recruit a minimum of 16 000 patient-years randomized to medical staff or computer-assisted dosage. In total, 13 219 patients participated, 6503 patients being randomized to medical staff and 6716 to computer-assisted dosage. The safety and effectiveness of computer-assisted dosage were compared with those of medical staff dosage. Results: In total, 13 052 patients were recruited (18 617 patient-years). International Normalized Ratio (INR) tests numbered 193 890 with manual dosage and 193 424 with computer-assisted dosage. The number of clinical events with computer-assisted dosage was lower (P = 0.1), but in the 3209 patients with deep vein thrombosis/pulmonary embolism, they were reduced by 37 (24%, P = 0.001). Time in target INR range was significantly improved by computer assistance as compared with medical staff dosage at the majority of centers (P <0.001). Conclusions: The safety and effectiveness of computer-assisted dosage has been demonstrated using two different marketed programs in comparison with experienced medical staff dosage at the centers with established interest in anticoagulation. Significant prevention of clinical events in patients with deep vein thrombosis/pulmonary embolism and the achievement of target INR in all clinical groups has been observed. The reliability and safety of other marketed computer-assisted dosage programs need to be established.

AB - Background: Increased demand for oral anticoagulants is overwhelming facilities worldwide, resulting in increasing use of computer assistance. A multicenter clinical endpoint study has been performed to compare the safety and effectiveness of computer-assisted dosage with dosage by experienced medical staff at the same centers. Methods: A randomized study of dosage of two commercial computer-assisted dosage programs (PARMA 5 and DAWN AC) vs. manual dosage at 32 centers with an established interest in oral anticoagulation in 13 countries. The aim was to recruit a minimum of 16 000 patient-years randomized to medical staff or computer-assisted dosage. In total, 13 219 patients participated, 6503 patients being randomized to medical staff and 6716 to computer-assisted dosage. The safety and effectiveness of computer-assisted dosage were compared with those of medical staff dosage. Results: In total, 13 052 patients were recruited (18 617 patient-years). International Normalized Ratio (INR) tests numbered 193 890 with manual dosage and 193 424 with computer-assisted dosage. The number of clinical events with computer-assisted dosage was lower (P = 0.1), but in the 3209 patients with deep vein thrombosis/pulmonary embolism, they were reduced by 37 (24%, P = 0.001). Time in target INR range was significantly improved by computer assistance as compared with medical staff dosage at the majority of centers (P <0.001). Conclusions: The safety and effectiveness of computer-assisted dosage has been demonstrated using two different marketed programs in comparison with experienced medical staff dosage at the centers with established interest in anticoagulation. Significant prevention of clinical events in patients with deep vein thrombosis/pulmonary embolism and the achievement of target INR in all clinical groups has been observed. The reliability and safety of other marketed computer-assisted dosage programs need to be established.

KW - safety

KW - effectiveness

KW - INR

KW - clinical events

KW - computer-assisted dosage

U2 - 10.1111/j.1538-7836.2008.02959.x

DO - 10.1111/j.1538-7836.2008.02959.x

M3 - Article

C2 - 18489430

SN - 1538-7836

VL - 6

SP - 935

EP - 943

JO - Journal of Thrombosis and Haemostasis

JF - Journal of Thrombosis and Haemostasis

IS - 6

ER -

An international multicenter randomized study of computer-assisted oral anticoagulant dosage vs. medical staff dosage

Abstract

Keywords

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