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Comparison of dosing algorithms for acenocoumarol and phenprocoumon using clinical factors with the standard care in the Netherlands

Lookup NU author(s): Professor Ann DalyORCiD


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© 2015 Elsevier Ltd. Background It has not been investigated how much the use of clinical factors in a dosing algorithm improves the percentage of time in therapeutic range (TTR). The present study aimed to compare the effect of dosing algorithms for acenocoumarol and phenprocoumon including clinical patient characteristics with standard care in the Netherlands. Setting: The pre-EU-PACT study, an observational study in the Netherlands, was used to obtain standard care data. Data from the Dutch patients in the EU-PACT trial (comparing the use of a clinical algorithm with and without genetic information) was used for the clinical dosing algorithm. Methods For both acenocoumarol and phenprocoumon, the percentage of time in, below and above therapeutic International Normalized Ratio (INR) range during 12 weeks after treatment initiation were assessed in both studies. Results During the weeks 2-12, the clinical dosing algorithm of acenocoumarol (80 patients) led to a higher TTR (74.3% versus 68.0% in range 2.0-3.5, 95% Confidence interval [CI] difference: 0.5% to 11.8%), and a reduced percentage of time below INR 2 and above INR 3.5, compared with standard care (272 patients). For phenprocoumon, compared with standard care (484 patients), 80 patients treated by the dosing algorithm did not obtained a significantly higher TTR in range 2.0-3.5 or a lower percentage of time above 3.5, however, they spent more time with INR below 2. Conclusion The use of a clinical dosing algorithm for acenocoumarol seemed to improve the quality of anticoagulation therapy during the treatment of initial 2-12 weeks. For phenprocoumon, there was no statistically difference in anticoagulation control.

Publication metadata

Author(s): Zhang Y, De Boer A, Verhoef TI, van der Meer FJM, Le Cessie S, Maitland-van der Zee AH, Barallon R, Daly A, Redekop K, Stingl J, Manolopoulos VG, Rosendaal FR, Wadelius M

Publication type: Article

Publication status: Published

Journal: Thrombosis Research

Year: 2015

Volume: 136

Issue: 1

Pages: 94-100

Print publication date: 01/07/2015

Online publication date: 02/05/2015

Acceptance date: 24/04/2015

ISSN (print): 0049-3848

ISSN (electronic): 1879-2472

Publisher: Elsevier Ltd


DOI: 10.1016/j.thromres.2015.04.034

PubMed id: 25971661


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