{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:08:57Z","timestamp":1777421337776,"version":"3.51.4"},"reference-count":21,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2016,10,26]],"date-time":"2016-10-26T00:00:00Z","timestamp":1477440000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ann Pharmacother"],"published-print":{"date-parts":[[2017,3]]},"abstract":"<jats:p>Background: The immediate postoperative warfarin sensitivity for patients receiving heart valve prostheses is increased. Established warfarin initiation protocols may lack clinical applicability, resulting in dosing based on clinical judgment. Objective: To compare current practice for warfarin initiation with a known warfarin initiation protocol, with doses proportionally reduced to account for the increased postoperative sensitivity. Methods: We compared the Mechanical Heart Valve Warfarin Initiation Protocol (Protocol group) with current practice (clinical judgment\u2014Empirical group) for patients receiving mechanical heart valves in an observational before-and-after format. End points were the time to achieve a stable therapeutic international normalized ratio (INR), doses held in the first 6 days, and overanticoagulation in the first 6 days. Results: The Protocol group (n = 37) achieved a stable INR more rapidly than the Empirical group (n = 77; median times 5.1 and 8.7 days, respectively; P = 0.002). Multivariable analysis indicated that the Protocol group (hazard ratio [HR] = 2.22; P = 0.005) and men (HR = 1.76; P = 0.043) more rapidly achieved a stable therapeutic INR. Age, serum albumin, amiodarone, presence of severe heart failure, and surgery type had no impact. Protocol patients had fewer doses held (1.1% vs 10.1%, P &lt; 0.001) and no difference in overanticoagulation (2.7% vs 9.1%, P = 0.27). Conclusion: The Mechanical Heart Valve Warfarin Initiation Protocol provided a reliable approach to initiating warfarin in patients receiving mechanical aortic or mitral valves.<\/jats:p>","DOI":"10.1177\/1060028016676830","type":"journal-article","created":{"date-parts":[[2016,10,26]],"date-time":"2016-10-26T20:39:01Z","timestamp":1477514341000},"page":"219-225","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["Comparing Usual Care With a Warfarin Initiation Protocol After Mechanical Heart Valve Replacement"],"prefix":"10.1177","volume":"51","author":[{"given":"Gregory","family":"Roberts","sequence":"first","affiliation":[{"name":"Flinders Medical Centre, Bedford Park, South Australia, Australia"},{"name":"Flinders University, Bedford Park, South Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rasha","family":"Razooqi","sequence":"additional","affiliation":[{"name":"University of South Australia, Adelaide, South Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephen","family":"Quinn","sequence":"additional","affiliation":[{"name":"Flinders University, Bedford Park, South Australia, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2016,10,26]]},"reference":[{"key":"bibr1-1060028016676830","doi-asserted-by":"publisher","DOI":"10.1378\/chest.11-2292"},{"key":"bibr2-1060028016676830","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehs109"},{"key":"bibr3-1060028016676830","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.02.536"},{"key":"bibr4-1060028016676830","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1G407"},{"key":"bibr5-1060028016676830","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(99)00463-4"},{"key":"bibr6-1060028016676830","doi-asserted-by":"publisher","DOI":"10.1002\/j.1875-9114.1998.tb03909.x"},{"key":"bibr7-1060028016676830","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2009.02.012"},{"key":"bibr8-1060028016676830","doi-asserted-by":"publisher","DOI":"10.2165\/00003088-198611060-00005"},{"key":"bibr9-1060028016676830","doi-asserted-by":"publisher","DOI":"10.1160\/TH10-05-0324"},{"key":"bibr10-1060028016676830","doi-asserted-by":"publisher","DOI":"10.1111\/j.1445-5994.1999.tb01623.x"},{"key":"bibr11-1060028016676830","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1A372"},{"key":"bibr12-1060028016676830","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.159.1.46"},{"key":"bibr13-1060028016676830","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-126-2-199701150-00006"},{"key":"bibr14-1060028016676830","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(01)01582-X"},{"key":"bibr15-1060028016676830","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.1980.tb00116.x"},{"key":"bibr16-1060028016676830","doi-asserted-by":"publisher","DOI":"10.1136\/jcp.45.8.704"},{"key":"bibr17-1060028016676830","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-116-11-901"},{"key":"bibr18-1060028016676830","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2125.1977.tb00718.x"},{"key":"bibr19-1060028016676830","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2796.2007.01913.x"},{"key":"bibr20-1060028016676830","doi-asserted-by":"publisher","DOI":"10.1378\/chest.121.1.19"},{"key":"bibr21-1060028016676830","doi-asserted-by":"publisher","DOI":"10.1177\/1060028015590438"}],"container-title":["Annals of Pharmacotherapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1060028016676830","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1060028016676830","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1060028016676830","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T11:16:39Z","timestamp":1777374999000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/1060028016676830"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,10,26]]},"references-count":21,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2017,3]]}},"alternative-id":["10.1177\/1060028016676830"],"URL":"https:\/\/doi.org\/10.1177\/1060028016676830","relation":{},"ISSN":["1060-0280","1542-6270"],"issn-type":[{"value":"1060-0280","type":"print"},{"value":"1542-6270","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,10,26]]}}}