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Comparing 5-mg and 10-mg Warfarin Loading Doses: Are the Groups Similar?
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We commend Crowther and colleagues1 on their comparison of 2 different loading doses of warfarin sodium, particularly given the wide variation of practices that exist. However, we question whether any concrete conclusions can be reached from the results. The major problem is in assuming that the study groups are equal in regard to characteristics.
It is well known that liver function, nutritional status, and certain foods and medications can all have major effects on the pharmacokinetics and pharmacodynamics of warfarin.2-3 It seems imperative, therefore, that Crowther and colleagues include information regarding these factors in their article, especially given the small number of subjects in the trial. Without this information, there is concern that the 2 groups could have been different, invalidating the results.
Steven Angelo, MD;
Robert J. Nardino, MD
New Haven, Conn
1. Crowther MA, Ginsberg JB, Kearon MB, et al. A randomized trial comparing 5-mg and 10-mg warfarin loading doses. Arch Intern Med. 1999;159:46-48.
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2. Hirsch J, Dalen JE, Anderson DR, et al. Oral anticoagulants: mechanism of action, clinical effectiveness, and optimal therapeutic range. Chest. 1998;114:445S-469S.
3. Wells PS, Holbrook AM, Crowther NR, Hirsch J. Interactions of warfarin with drugs and food. Ann Intern Med. 1994;121:676-683.
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In reply
Drs Angelo and Nardino are concerned about possible imbalances in the baseline characteristics of the . . . [Full Text of this Article]
RELATED ARTICLE
A Randomized Trial Comparing 5-mg and 10-mg Warfarin Loading Doses
Mark. A. Crowther, Jeff B. Ginsberg, Clive Kearon, Linda Harrison, J. Johnson, M. Patricia Massicotte, and Jack Hirsh
Arch Intern Med. 1999;159(1):46-48.
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