title: Guidance for the practical management of warfarin therapy in the treatment of venous thromboembolism.
abstract: Venous thromboembolism (VTE) is a serious and often fatal medical condition with an increasing incidence. The treatment of VTE is undergoing tremendous changes with the introduction of the new direct oral anticoagulants and clinicians need to understand new treatment paradigms. This article, initiated by the Anticoagulation Forum, provides clinical guidance based on existing guidelines and consensus expert opinion where guidelines are lacking. Well-managed warfarin therapy remains an important anticoagulant option and it is hoped that anticoagulation providers will find the guidance contained in this article increases their ability to achieve optimal outcomes for their patients with VTE Pivotal practical questions pertaining to this topic were developed by consensus of the authors and were derived from evidence-based consensus statements whenever possible. The medical literature was reviewed and summarized using guidance statements that reflect the consensus opinion(s) of all authors and the endorsement of the Anticoagulation Forum's Board of Directors. In an effort to provide practical and implementable information about VTE and its treatment, guidance statements pertaining to choosing good candidates for warfarin therapy, warfarin initiation, optimizing warfarin control, invasive procedure management, excessive anticoagulation, subtherapeutic anticoagulation, drug interactions, switching between anticoagulants, and care transitions are provided.
authors.affiliation: University of Utah College of Pharmacy, 30 South 2000 East, Salt Lake City, UT, 84112, USA. dan.witt@pharm.utah.edu.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Witt
authors.affiliation: Clinical Pharmacy Anticoagulation and Anemia Services, Kaiser Permanente Colorado, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Services, Aurora, CO, USA.
authors.forename: Nathan P
authors.initials: NP
authors.lastname: Clark
authors.affiliation: Hurley Medical Center, Flint, MI, USA.|College of Human Medicine, Michigan State University, East Lansing, MI, USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Kaatz
authors.affiliation: Thromboembolism Research and Thoracic Surgery Research, St. Joseph's Healthcare, Hamilton, ON, Canada.
authors.forename: Terri
authors.initials: T
authors.lastname: Schnurr
authors.affiliation: Hofstra North Shore/LIJ School of Medicine, Hempstead, NY, USA.
authors.forename: Jack E
authors.initials: JE
authors.lastname: Ansell
mesh_terms: D006801:Humans; D017410:Practice Guidelines as Topic; D054556:Venous Thromboembolism / Q000188:drug therapy*; D014859:Warfarin / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D014859:Warfarin
keywords: Anticoagulation; Anticoagulation clinics; Anticoagulation-related bleeding; Coumadin; Direct oral anticoagulants (DOAC); Drug interactions; INR; Risk factors; Venous thromboembolism; Warfarin