Initiation of warfarin therapy: recommendations and clinical pearls

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.