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Am Fam Physician. 1999 Feb 1;59(3):635-46.

Warfarin therapy: evolving strategies in anticoagulation.

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  • 1Department of Pharmacy, York Hospital, PA 17405, USA.

Erratum in

  • Am Fam Physician 2002 Jan 15;65(2):172.
  • Am Fam Physician. 2006 Mar 15;73(6):974.
  • Am Fam Physician 1999 Oct 1;60(5):1333.


Warfarin is the oral anticoagulant most frequently used to control and prevent thromboembolic disorders. Prescribing the dose that both avoids hemorrhagic complications and achieves sufficient suppression of thrombosis requires a thorough understanding of the drug's unique pharmacology. Warfarin has a complex dose-response relationship that makes safe and effective use a challenge. For most indications, the dose is adjusted to maintain the patient's International Normalized Ratio (INR) at 2 to 3. Because of the delay in factor II (prothrombin) suppression, heparin is administered concurrently for four to five days to prevent thrombus propagation. Loading doses of warfarin are not warranted and may result in bleeding complications. Interactions with other drugs must be considered, and therapy in elderly patients requires careful management. Current dosing recommendations are reviewed, and practical guidelines for the optimal use of warfarin are provided.

Comment in

  • Monitoring warfarin therapy. [Am Fam Physician. 1999]
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