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[Oral anticoagulation treatment--control, risks, benefits, and informed consent]
Paul Froom1, Doron Hermoni, Mira Barak
1Dept of Family Medicine, Technion Faculty of Medicine, and General Health Services, Haifa.
Harefuah
|March 22, 2003
Summary
Warfarin therapy for atrial fibrillation, mechanical heart valves, and venous thromboembolism requires careful monitoring. Challenges in maintaining the International Normalized Ratio (INR) range and patient understanding of risks highlight the need for informed consent.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Context:
- Warfarin is a common anticoagulant for atrial fibrillation, mechanical heart valves, and venous thromboembolism.
- Current guidelines for warfarin therapy are well-established but challenging to implement.
- Maintaining the Prothrombin Time (PT) in the International Normalized Ratio (INR) therapeutic range is often difficult.
Purpose:
- To review current recommendations for long-term oral anticoagulant management.
- To identify challenges associated with PT-INR testing and interpretation.
- To emphasize the importance of informed consent in warfarin therapy.
Summary:
- Despite established guidelines, achieving and maintaining the target INR range for warfarin therapy presents significant clinical challenges.
- Physicians may underestimate the limitations of INR testing and the persistent risks of thromboembolic and bleeding events.
- This review addresses management recommendations, testing issues, urgent laboratory communication, and patient information for informed consent.
Impact:
- Highlights the gap between warfarin therapy guidelines and clinical practice.
- Underscores the medico-legal risks associated with suboptimal anticoagulation monitoring.
- Provides a framework for improving patient understanding and informed consent in warfarin management.