Implementation of a Computerized Decision Support System for Warfarin Dosing in Hemodialysis Patients: A Study of Effectiveness and Safety

• Main Author: Edward, Clark
• Other Authors: Marc, Rodger
• Language: en
• Published: Université d'Ottawa / University of Ottawa 2015
• Subjects: Warfarin; Anticoagulation; Computerized decision support systems; Hemodialysis; Renal failure
• Online Access: http://hdl.handle.net/10393/31998; http://dx.doi.org/10.20381/ruor-2735

Statement of the problem: The risk-benefit profile of warfarin anticoagulation in hemodialysis (HD) patients differs compared to the non-HD population. Computerized decision support systems (CDSS) to assist with anticoagulation management are safe and effective in the non-HD population but had not previously been studied in HD outpatients. Methods of investigation: A before – after study compared anticoagulation control during pre-existing, nephrologist-led anticoagulation management to that following implementation of a pharmacist-led, CDSS-assisted strategy, in HD patients on warfarin at The Ottawa Hospital. Results: Forty-two patients were included. Following implementation of the CDSS-assisted strategy, median time-in-range increased by 3.7% (IQR, -9.5% - 20.6%; p = 0.247). Median frequency of INR tests per day decreased: -0.040 (IQR, -0.074 to –0.0008; P = 0.0001). Adverse events were similar. Conclusion: A CDSS-assisted strategy for anticoagulation management in HD patients is effective, safe and may lead to cost savings related to less frequent INR testing.