[Oral anticoagulation treatment--control, risks, benefits, and 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.