The most common anticoagulant is often poorly prescribed and adhered to
In the past 25 years the number of patients who take oral anticoagulants has risen substantially, and the most common anticoagulant is warfarin. Many people take warfarin for the treatment and prevention of thromboembolic disorders. Maintenance is mostly in hospital but more recently in community anticoagulation clinics. However, starting patients with warfarin is often done on an inpatient basis and mostly by junior doctors or specially trained nurses or pharmacists. Warfarin can be a difficult drug to prescribe because it requires dosing specific to individual patients, and it interacts with many drugs. Its use is prevalent in elderly people.
Guidelines from the British Committee for Standards in Haematology recommend that patients who need warfarin rapidly should be started according to a recognised schedule,1 for example, that described by Fennerty and colleagues.2 Slow initiation of warfarin may be appropriate for some outpatients.
To understand how warfarin works, it is important