It is a challenge to be able to prescribe the optimal initial dose ofwarfarin. There have beenmany studies focused on an efficient strategy\nto determine the optimal initial dose.Numerous clinical, genetic, and environmental factors affect thewarfarin dose response. In\npractice, it is common that the initial warfarin dose is substantially different fromthe stable maintenance dose, whichmay increase\nthe risk of bleeding or thrombosis prior to achieving the stablemaintenance dose. In order to minimize the risk of misdosing, despite\npopular warfarin dose predictionmodels in the literature which create dose predictions solely based on patients� attributes, we have\ntaken physicians� opinions towards the initial dose into consideration. The initial doses selected by clinicians, along with other\nstandard clinical factors, are used to determine an estimate of the difference between the initial dose and estimated maintenance\ndose using shrinkage methods.Theselected shrinkage method was LASSO (Least Absolute Shrinkage and Selection Operator).The\nestimated maintenance dose was more accurate than the original initial dose, the dose predicted by a linear model without involving\nthe clinicians initial dose, and the values predicted by the most commonly used model in the literature, the Gage clinical model.
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