PT  - JOURNAL ARTICLE
AU  - Denis Macdonald
AU  - Pearl Bhalla
AU  - William Cass
AU  - Jeff Gollish
AU  - Roger Brighton
AU  - Frayda Gorenstein
AU  - Joseph Vitunjski
AU  - Peggy Ng
TI  - Computerized management of oral anticoagulant therapy: experience in major joint arthroplasty
DP  - 2002 Feb 01
TA  - Canadian Journal of Surgery
PG  - 47--52
VI  - 45
IP  - 1
4099  - http://canjsurg.ca/content/45/1/47.short
4100  - http://canjsurg.ca/content/45/1/47.full
SO  - CAN J SURG2002 Feb 01; 45
AB  - Objective: Evaluation of the safety and potential cost savings of a computerized, laboratory-based program to manage inpatient warfarin thromboprophylaxis after major joint arthroplasty.Design: A consecutive-case study of adults.Setting: A tertiary care orthopedic institution.Patients: Patients requiring joint arthroplasty who had no recent episodes of thromboembolic disease, no mechanical heart valve, atrial fibrillation, severe liver disease or baseline international normalized ratio [INR] greater than 1.3 admitted over a 54-month period (July 1994–December 1998). All patients received a standard regimen of warfarin beginning on the evening after the operation. Four hundred and thirty randomly selected patients managed by the program were followed up by telephone survey 3 months after discharge. Patients exhibiting erratic responses to warfarin were withdrawn from the program and managed individually thereafter.Intervention: Major joint arthroplasty with warfarin therapy administered through the computerized program.Main outcome measures: Test results maintained within the desired therapeutic range (INR 2.0–3.0), clinically severe bleeding episodes, readmission rates, clinically symptomatic and venographically proven episodes of venous thrombosis or pulmonary embolism.Results: Over the study period 5629 patients underwent joint arthroplasty; 5372 patients were considered for the program; 332 patients were ineligible and were managed individually; 311 entered patients did not complete the program. This left 4729 patients who completed the program. In 2932 (62%) patients test results were maintained in the desired therapeutic range. The major bleeding rate was less than 0.5%, the readmission rate was 3.8%, the deep venous thrombosis rate was 3.7% and the pulmonary embolism rate was 0.2% with no thromboembolic related deaths in the small sample cohort.Conclusions: The majority of patients requiring warfarin thromboprophylaxis can be safely and effectively managed by this laboratory-based computerized program while in hospital. Significant potential cost savings in nursing time could be achieved.