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Table 4 Summary of primary outcome results (Time to stable INR, supra = therapeutic INR, sub-terapeutic INRs, vitamin K given, and serious adverse events)

From: Optimal loading dose for the initiation of warfarin: a systematic review

  

Proportion in INR range

       

Study

Dosing

Day 3

(95% CI)

Day 5

95% (CI)

Mean time to time in range

Days (SD)

INR ≥4 unless otherwise stated

%

Vit K

Given

N (%)

Serious

Adverse

Events

N (%)

Other primary endpoints

5 mg v 10 mg

         

   Harrison

5 mg

42%

67%δ

-

-

1(4%)

0

   
 

10 mg

36%

80%δ

-

-

4(16%)

0

   

Crowther

5 mg

50% (26 to 75)

88%(75 to 102)

-

-

1(3%)

-

INR 2.0-3.0 for 2 consecutive days & not >3.0;

p < .003

 

10 mg

33% (-2 to 68)

69% (39 to 99)

-

-

0

-

10 mg (24%) v 5 mg (66%)

RR 2.22 (95% CI 1.3-3.7)

  

Kovacs

5 mg

3%*

46%

(36 to 57)**

P<.001

5.6 (1.4)

INR ≥5

11%

-

2 (2%)

   
 

10 mg

25%*

83%

(74 to 89)**

 

4.2 (1.1)

9%

-

4 (4%)

  

   Quiroz

5 mg

-

52%**

Median 5

INR >5

0%

-

0

   
 

10 mg

-

56%**

Median 5

0%

-

1 (4%)

   
  

*taken from the published graph

δincludes discharged with INR in-range from (Ann Int Med Vol 127, 4, pg 133)

** in-range by day 5

5 mg vs. other doses

         

   Ageno

5 mg

-

-

2.0 (1.0)

P < .0001

-

3 (3%)

0

INR > 2.6

5 mg (42%)

p < .05

 

2.5 mg

-

-

2.7 (1.2)

P < .0001

-

5 (6%)

0

2.5 mg (26%)

p < .05

   Shine

Std (5 mg)

-

63% δ

5 (0.9) ψ

P = .007

"high" INR 2%

-

1 (2%)

   
 

Calc

-

77% δ

4.2 (0.9)ψ

P = .007

INR >4.4 5%

-

1 (2%)

   
  

δINR within range on or before day 6

ψ completers only

Age trials

           

   Roberts

Age adjusted

 

47%*

3.7 (1.3) Φ

6%

-

0 Φ

INR 2.0 - 3.0 for 2 consecutive days

  
 

Fennerty

 

25%*

4.3 (1.2) Φ

32%

-

0 Φ

Age v Fennerty;

 

p = 0.003

     

INR >4.5

  

Mean days in range (SD)

 

   Gedge

Age

65-75 yrs

-

-

4.6 (1.6)

P = .03

3% P < .05

0

0

Age

3.0 (1.3)

p = 0.03

 

New Fennerty 65-75 yrs

-

-

3.8 (0.8)

P = .03

20% P < .05

^

0

New Fennerty

2.7 (1.3)

p = 0.03

     

INR >4.5

  

Mean days in range (SD)

 
 

Age

>75 yrs

-

-

4.5 (1.4)

P = .003

3% P < .01

0

0

Age

2.9 (1.1)

p = 0.04

 

New Fennerty

>75 yrs

-

-

3.5 (0.7)

P = .003

37% P < .01

^

0

New Fennerty

2.4 (1.3)

p = 0.04

  

*taken from the published graph

Φ author correspondence

^ 1 (age not stated)

Genotyping

           

   Hillman

Model

-

-

-

33%

0

2 (10%)

% time INR in range

5 mg 42%

 
 

5 mg

-

-

-

30%

2 (doses)

5 (28%)

Model 42%

 

   Anderson

Model

-

70%

-

30%

-

4 (4%)

average % of INR outside range

10 mg 33%

 
 

10 mg

-

68%

-

37%

-

5 (5%)

Model 31%

 
         

% time INR in range

 

   Caraco

Model

1% *

49% *

4.8 (1.5)

P < .001

-

0

0

5 mg 25%

P < 0.001

 

STD 5 mg

1% *

11% *

7.5 (3.1)

P < .001

-

1 (1%)

1 (1%)

Model 45%

P < 0.001

 

*taken from the published graph