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Multicomponent comprehensive care was as effective as usual care for decreasing major bleeding in older patients on warfarin

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 QUESTION: In older patients requiring warfarin, is multicomponent comprehensive care (MCC) more effective than usual care for reducing major bleeding events?


Randomised {allocation concealed*}, blinded (data collectors and outcome assessors),* controlled trial with 6 months follow up.


Cuyahoga County, Ohio, USA.


325 patients (mean age 75 y, 57% women) who were ≥ 65 years of age, received ≥10 000 units of intravenous unfractionated heparin, resided in the area, and had planned warfarin treatment for ≥10 days. Exclusion criteria included treatment with warfarin in the previous 6 months, admission from a nursing home, or enrolment in another clinical trial. Follow up was complete.


163 patients were allocated to MCC, which consisted of a guideline based consultation and patient education, coaching, and self monitoring of prothrombin time with a portable monitor. Home visits were made 3 days after discharge to assess the patients' ability …

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  • Sources of funding: National Institute on Aging; Department of Veterans Affairs Health Services Research and Development Service; American Federation for Aging Research; Claude D Pepper Older Americans Independence Center of Case Western Reserve University.

  • For correspondence: Dr R J Beyth, Baylor College of Medicine and Houston Center for Quality of Care and Utilization Studies, Houston VAMC (39A), 2002 Holcombe Boulevard, Houston, TX 77030, USA. Fax +1 713 558 4593.

  • * See glossary.

  • Information provided by author.