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Initiation of Warfarin Therapy: Recommendations and Clinical Pearls

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Abstract

Warfarin is a commonly used medication with a narrow therapeutic index. The initiation of warfarin requires consideration of a variety of factors, which include reviewing the indications and contraindications for this agent, performing a thorough clinical assessment along with a risk-benefit analysis for anticoagulation, consideration of warfarin pharmacology, developing strategies to monitor the intensity of anticoagulation and for the detection of adverse events, and education of the patient. The process of warfarin initiation has been studied by many researchers, but much of this literature has not been employed in clinical practice. This article presents a strategy for the clinician to use when initiating patients on warfarin.

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References

  1. Spandorfer JM, Merli GM. Outpatient anticoagulation issues for the primary care physician. Med Clin North Am 1996;80:475–491.

    PubMed  Google Scholar 

  2. Laupacis A, Albers G, Dalen J, Dunn M, Feinberg W, Jacobson A. Antithrombotic therapy in atrial fibrillation. Chest 1995;108(4Suppl): 352S–359S.

    Google Scholar 

  3. Hirsh J, Dalen JE, Deykin D, Poller L, Bussey H. Oral anticoagulants: Mechanism of action, clinical effectiveness, and optimal therapeutic range. Chest 1995;108(4Suppl.): 231S–241S.

    PubMed  Google Scholar 

  4. Coumadin® package insert (6386–04), Revised August 1996.

  5. Ansell JE. Oral anticoagulant therapy—50 years later. Arch Intern Med 1993;153:586–596.

    PubMed  Google Scholar 

  6. Laupacis A, Albers G, Dalen J, Dunn M, Feinberg W, Jacobson A. Antithrombotic therapy in atrial fibrillation. Chest 1995;108(4Suppl):352S–359S.

    PubMed  Google Scholar 

  7. Hansten P, Wittkowsky AK. Warfarin drug interactions. In Ansell JE, Oertel LB, Wittkowsky AK, eds: Managing Oral Anticoagulation Therapy. Gaithersburg, MD: Aspen, 1997:4B-7:1–4B-7:11.

    Google Scholar 

  8. Hirsh J, Fuster V. Guide to anticoagulant therapy part 2: Oral anticoagulants. Circulation 1994;89:1469–1480.

    PubMed  Google Scholar 

  9. Harrison L, Johnston M, Massicotte MP, Crowther, Moffatt K, Hirsh J. Comparison of 5-mg and 10-mg loading doses in initiation of warfarin therapy. Ann Intern Med 1997;126:133–136.

    PubMed  Google Scholar 

  10. Bussey HI, Rospond RM, Quandt CM, Clark GM. The safety and effectiveness of long-term warfarin therapy in an anticoagulation clinic. Pharmacotherapy 1989;9:214–219.

    PubMed  Google Scholar 

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Erban, S. Initiation of Warfarin Therapy: Recommendations and Clinical Pearls. J Thromb Thrombolysis 7, 145–148 (1999). https://doi.org/10.1023/A:1008833520158

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  • DOI: https://doi.org/10.1023/A:1008833520158

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