Clinical versus fixed warfarin dosing and the impact on quality of anticoagulation (The ClinFix trial)

<p dir="ltr">Different dosing strategies exist to initiate warfarin, most commonly fixed warfarin dosing (FWD), clinical warfarin dosing (CWD), and genetic‐guided warfarin dosing (GWD). Landmark trials have shown GWD to be superior when compared to FWD in the EU‐PACT trial or CWD in...

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Main Author: Amr M. Fahmi (21632909) (author)
Other Authors: Ahmed El Bardissy (21632912) (author), Mohamed Omar Saad (12535545) (author), Mohamed Nabil Elshafei (9960500) (author), Loulia Bader (14151585) (author), Ahmed Mahfouz (737928) (author), Mohamed Kasem (8602740) (author), Osama Abdelsamad (14151600) (author), Abdelnasser Elzouki (21632915) (author), Christina L. Aquilante (8106603) (author), Fatima Mraiche (715733) (author), Ezeldin Soaly (14151603) (author), Ihab El Madhoun (21632918) (author), Nidal Asaad (284935) (author), Abdulrahman Arabi (8100536) (author), Eman Alhmoud (13955766) (author), Hazem Elewa (3592601) (author)
Published: 2024
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author Amr M. Fahmi (21632909)
author2 Ahmed El Bardissy (21632912)
Mohamed Omar Saad (12535545)
Mohamed Nabil Elshafei (9960500)
Loulia Bader (14151585)
Ahmed Mahfouz (737928)
Mohamed Kasem (8602740)
Osama Abdelsamad (14151600)
Abdelnasser Elzouki (21632915)
Christina L. Aquilante (8106603)
Fatima Mraiche (715733)
Ezeldin Soaly (14151603)
Ihab El Madhoun (21632918)
Nidal Asaad (284935)
Abdulrahman Arabi (8100536)
Eman Alhmoud (13955766)
Hazem Elewa (3592601)
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author_facet Amr M. Fahmi (21632909)
Ahmed El Bardissy (21632912)
Mohamed Omar Saad (12535545)
Mohamed Nabil Elshafei (9960500)
Loulia Bader (14151585)
Ahmed Mahfouz (737928)
Mohamed Kasem (8602740)
Osama Abdelsamad (14151600)
Abdelnasser Elzouki (21632915)
Christina L. Aquilante (8106603)
Fatima Mraiche (715733)
Ezeldin Soaly (14151603)
Ihab El Madhoun (21632918)
Nidal Asaad (284935)
Abdulrahman Arabi (8100536)
Eman Alhmoud (13955766)
Hazem Elewa (3592601)
author_role author
dc.creator.none.fl_str_mv Amr M. Fahmi (21632909)
Ahmed El Bardissy (21632912)
Mohamed Omar Saad (12535545)
Mohamed Nabil Elshafei (9960500)
Loulia Bader (14151585)
Ahmed Mahfouz (737928)
Mohamed Kasem (8602740)
Osama Abdelsamad (14151600)
Abdelnasser Elzouki (21632915)
Christina L. Aquilante (8106603)
Fatima Mraiche (715733)
Ezeldin Soaly (14151603)
Ihab El Madhoun (21632918)
Nidal Asaad (284935)
Abdulrahman Arabi (8100536)
Eman Alhmoud (13955766)
Hazem Elewa (3592601)
dc.date.none.fl_str_mv 2024-06-10T09:00:00Z
dc.identifier.none.fl_str_mv 10.1111/cts.13797
dc.relation.none.fl_str_mv https://figshare.com/articles/journal_contribution/Clinical_versus_fixed_warfarin_dosing_and_the_impact_on_quality_of_anticoagulation_The_ClinFix_trial_/29445467
dc.rights.none.fl_str_mv CC BY 4.0
info:eu-repo/semantics/openAccess
dc.subject.none.fl_str_mv Biomedical and clinical sciences
Cardiovascular medicine and haematology
Pharmacology and pharmaceutical sciences
Warfarin dosing
Clinical warfarin dosing (CWD)
Fixed warfarin dosing (FWD)
Genetic-guided warfarin dosing (GWD)
Anticoagulation
dc.title.none.fl_str_mv Clinical versus fixed warfarin dosing and the impact on quality of anticoagulation (The ClinFix trial)
dc.type.none.fl_str_mv Text
Journal contribution
info:eu-repo/semantics/publishedVersion
text
contribution to journal
description <p dir="ltr">Different dosing strategies exist to initiate warfarin, most commonly fixed warfarin dosing (FWD), clinical warfarin dosing (CWD), and genetic‐guided warfarin dosing (GWD). Landmark trials have shown GWD to be superior when compared to FWD in the EU‐PACT trial or CWD in the GIFT trial. COAG trial did not show differences between GWD and CWD. We aim to compare the anticoagulation quality outcomes of CWD and FWD. This is a prospective cohort study with a retrospective comparator. Recruited subjects in the CWD (prospective) arm were initiated on warfarin according to the clinical dosing component of the algorithm published in www.warfarindosing.org. The primary efficacy outcome was the percentage time in the therapeutic range (PTTR) from day 3 to 6 till day 28 to 35. The study enrolled 122 and 123 patients in the CWD and FWD, respectively. The PTTR did not differ statistically between CWD and FWD (62.2 ± 26.2% vs. 58 ± 25.4%, <i>p</i> = 0.2). There was also no difference between both arms in the percentage of visits with extreme subtherapeutic international normalized ratio (INR) (<1.5; 15 ± 18.3% vs. 16.8 ± 19.1%, <i>p</i> = 0.44) or extreme supratherapeutic INR (>4; 7.7 ± 14.7% vs. 7.5 ± 12.4%, <i>p</i> = 0.92). We conclude that CWD did not improve the anticoagulation quality parameters compared to the FWD method.</p><h2>Other Information</h2><p dir="ltr">Published in: Clinical and Translational Science<br>License: <a href="http://creativecommons.org/licenses/by/4.0/" target="_blank">http://creativecommons.org/licenses/by/4.0/</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1111/cts.13797" target="_blank">https://dx.doi.org/10.1111/cts.13797</a></p>
eu_rights_str_mv openAccess
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identifier_str_mv 10.1111/cts.13797
network_acronym_str Manara2
network_name_str Manara2
oai_identifier_str oai:figshare.com:article/29445467
publishDate 2024
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spelling Clinical versus fixed warfarin dosing and the impact on quality of anticoagulation (The ClinFix trial)Amr M. Fahmi (21632909)Ahmed El Bardissy (21632912)Mohamed Omar Saad (12535545)Mohamed Nabil Elshafei (9960500)Loulia Bader (14151585)Ahmed Mahfouz (737928)Mohamed Kasem (8602740)Osama Abdelsamad (14151600)Abdelnasser Elzouki (21632915)Christina L. Aquilante (8106603)Fatima Mraiche (715733)Ezeldin Soaly (14151603)Ihab El Madhoun (21632918)Nidal Asaad (284935)Abdulrahman Arabi (8100536)Eman Alhmoud (13955766)Hazem Elewa (3592601)Biomedical and clinical sciencesCardiovascular medicine and haematologyPharmacology and pharmaceutical sciencesWarfarin dosingClinical warfarin dosing (CWD)Fixed warfarin dosing (FWD)Genetic-guided warfarin dosing (GWD)Anticoagulation<p dir="ltr">Different dosing strategies exist to initiate warfarin, most commonly fixed warfarin dosing (FWD), clinical warfarin dosing (CWD), and genetic‐guided warfarin dosing (GWD). Landmark trials have shown GWD to be superior when compared to FWD in the EU‐PACT trial or CWD in the GIFT trial. COAG trial did not show differences between GWD and CWD. We aim to compare the anticoagulation quality outcomes of CWD and FWD. This is a prospective cohort study with a retrospective comparator. Recruited subjects in the CWD (prospective) arm were initiated on warfarin according to the clinical dosing component of the algorithm published in www.warfarindosing.org. The primary efficacy outcome was the percentage time in the therapeutic range (PTTR) from day 3 to 6 till day 28 to 35. The study enrolled 122 and 123 patients in the CWD and FWD, respectively. The PTTR did not differ statistically between CWD and FWD (62.2 ± 26.2% vs. 58 ± 25.4%, <i>p</i> = 0.2). There was also no difference between both arms in the percentage of visits with extreme subtherapeutic international normalized ratio (INR) (<1.5; 15 ± 18.3% vs. 16.8 ± 19.1%, <i>p</i> = 0.44) or extreme supratherapeutic INR (>4; 7.7 ± 14.7% vs. 7.5 ± 12.4%, <i>p</i> = 0.92). We conclude that CWD did not improve the anticoagulation quality parameters compared to the FWD method.</p><h2>Other Information</h2><p dir="ltr">Published in: Clinical and Translational Science<br>License: <a href="http://creativecommons.org/licenses/by/4.0/" target="_blank">http://creativecommons.org/licenses/by/4.0/</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1111/cts.13797" target="_blank">https://dx.doi.org/10.1111/cts.13797</a></p>2024-06-10T09:00:00ZTextJournal contributioninfo:eu-repo/semantics/publishedVersiontextcontribution to journal10.1111/cts.13797https://figshare.com/articles/journal_contribution/Clinical_versus_fixed_warfarin_dosing_and_the_impact_on_quality_of_anticoagulation_The_ClinFix_trial_/29445467CC BY 4.0info:eu-repo/semantics/openAccessoai:figshare.com:article/294454672024-06-10T09:00:00Z
spellingShingle Clinical versus fixed warfarin dosing and the impact on quality of anticoagulation (The ClinFix trial)
Amr M. Fahmi (21632909)
Biomedical and clinical sciences
Cardiovascular medicine and haematology
Pharmacology and pharmaceutical sciences
Warfarin dosing
Clinical warfarin dosing (CWD)
Fixed warfarin dosing (FWD)
Genetic-guided warfarin dosing (GWD)
Anticoagulation
status_str publishedVersion
title Clinical versus fixed warfarin dosing and the impact on quality of anticoagulation (The ClinFix trial)
title_full Clinical versus fixed warfarin dosing and the impact on quality of anticoagulation (The ClinFix trial)
title_fullStr Clinical versus fixed warfarin dosing and the impact on quality of anticoagulation (The ClinFix trial)
title_full_unstemmed Clinical versus fixed warfarin dosing and the impact on quality of anticoagulation (The ClinFix trial)
title_short Clinical versus fixed warfarin dosing and the impact on quality of anticoagulation (The ClinFix trial)
title_sort Clinical versus fixed warfarin dosing and the impact on quality of anticoagulation (The ClinFix trial)
topic Biomedical and clinical sciences
Cardiovascular medicine and haematology
Pharmacology and pharmaceutical sciences
Warfarin dosing
Clinical warfarin dosing (CWD)
Fixed warfarin dosing (FWD)
Genetic-guided warfarin dosing (GWD)
Anticoagulation