A Rising Tide for Its Clinical Value

نویسنده

  • Julie A. Johnson
چکیده

Warfarin has been in clinical use for nearly 60 years, and in 2010 there were 25 million prescriptions for warfarin in the United States. Although warfarin is highly efficacious, it has a narrow therapeutic window to achieve desired anticoagulation without excess risk of bleeding. Anticoagulation status is monitored with the International Normalized Ratio (INR), where the most common target INR is 2 to 3. Not only does warfarin exhibit a narrow therapeutic index, but there can be 10to 20-fold differences in the warfarin dose required to achieve target INR. Thus, the early period after warfarin therapy initiation requires frequent INR monitoring to determine the proper dose for the patient, it is often associated with multiple dose adjustments, and many patients experience prolonged periods of overor underanticoagulation while the appropriate dose is identified. These challenges lead to warfarin being a leading cause of emergency department visits and hospitalizations for an adverse drug reaction and to significant underuse of the drug in patients for whom it is strongly indicated, in particular, those with atrial fibrillation.1

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تاریخ انتشار 2012