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Is drug dosing best left to computers? Maybe, according to British investigators who recently reported that computerized anticoagulant dosing may be more effective than traditional methods, where medical staff decide whether or not doses should be increased, decreased, or remain unchanged, and the length of time that should elapse before the patient’s next visit.1
The researchers used a computer program that generates dosing schedules and conducted a prospective, multicenter trial involving 285 patients who were all on anticoagulant therapy, either in the first stages of therapy when a maintenance dose is established or in a stable routine of anticoagulation. Participants were randomized to either computerized or traditional anticoagulant dosing for periods of at least three months.
During the first few weeks of the trial, staffers made many of the decisions themselves, owing to mistrust of the computer program. But after a few weeks, they stopped intervening and used only computerized doses to monitor patients. The authors wrote that the program maintained international normalized ratio (INR) control better than the experienced medical staff. Patients randomized to computer dosing spent an average of 63% of treatment days within target INR range, compared with 53% of days among subjects in the traditional-dosing group. The authors speculate that a wider use of computerized dosing could substantially save medical, nursing, and administrative time; and human attention could be concentrated on the few patients who present unusual difficulties for anticoagulant control.
1. Poller L, et al. Multicentre randomised study of computerised anticoagulant dosage. Lancet 1998; 352:1,505-1,509.