Skip to main content
SpringerLink
Log in

Ambulatory Warfarin Management

  • Chapter
Anticoagulation Management

  • 1049 Accesses

Abstract

Warfarin is the most commonly prescribed oral vitamin K antagonist worldwide. It is used when long-term oral anticoagulation is desired for a variety of indications including, atrial fibrillation, mechanical heart valve replacement, venous thromboembolism, etc. A major challenge to the management of warfarin is the narrow therapeutic window needed for both the safety and efficacy of the drug. When below the therapeutic range, an increased risk of death from stroke or other thromboembolic events can occur, and when above therapeutic range, it can increase the risk for bleeding.

Pharmacist management of warfarin in the ambulatory setting is associated with improved outcomes and decreased adverse events. This chapter will focus on describing the role of the pharmacist in outpatient warfarin management and provide examples of warfarin management plans, dosing nomograms, monitoring, documentation, and patient education.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 54.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Wysowski DK, Nourjah P, Swartz L (2007) Bleeding complications with warfarin use: a prevalent adverse effect resulting in regulatory action. Arch Intern Med 167(13):1414–1419

    Article  PubMed  Google Scholar 

  2. Pirmohamed M (2006) Warfarin: almost 60 years old and still causing problems. Br J Clin Pharmacol 62(5):509–511

    Article  PubMed Central  PubMed  Google Scholar 

  3. Holbrook AM, Pereira JA, Labiris R, McDonald H, Douketis JD, Crowther M, Wells PS (2005) Systematic overview of warfarin and its drug and food interactions. Arch Intern Med 165:1095–1106

    Article  CAS  PubMed  Google Scholar 

  4. Burns M (1999) Management of narrow therapeutic index drugs. J Thromb Thrombolysis 7:137–143

    Article  CAS  PubMed  Google Scholar 

  5. Schulman S, Beyth RJ, Kearon C, Levine MN (2008) Hemorrhagic complications of anticoagulant and thrombolytic treatment: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133:257S–298S

    Article  CAS  PubMed  Google Scholar 

  6. Koo S, Kucher N, Nguyen PL, Fanikos J, Marks PW, Goldhaber SZ (2004) The effect of excessive anticoagulation on mortality and morbidity in hospitalized patients with anticoagulant-related major hemorrhage. Arch Intern Med 164:1557–1560

    Article  PubMed  Google Scholar 

  7. Ansell J, Hirsh J, Hylek E, Jacobson A, Crowther M, Palareti G (2008) Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest 133:160S–198S

    Article  CAS  PubMed  Google Scholar 

  8. Oake N, Jennings A, Forster AJ, Fergusson D, Doucette S, van Walraven C (2008) Anticoagulation intensity and outcomes among patients prescribed oral anticoagulant therapy: a systematic review and meta-analysis. Can Med Assoc J 179(3):235–244

    Article  Google Scholar 

  9. Oake N, Fergusson DA, Forster AJ, van Walraven C (2007) Frequency of adverse events in patients with poor anticoagulation: a meta-analysis. Can Med Assoc J 176(11):1589–1594. doi:10.1503/cmaj.061523

    Article  Google Scholar 

  10. Hylek EM, Chang YC, Skates SJ, Hughes RA, Singer DE (2000) Prospective study of the outcomes of ambulatory patients with excessive warfarin anticoagulation. Arch Intern Med 160:1612–1617

    Article  CAS  PubMed  Google Scholar 

  11. Hope KA, Havrda DE (2001) Subtherapeutic INR values associated with a switch to generic warfarin. Ann Pharmacother 35(2):183–187

    Article  CAS  PubMed  Google Scholar 

  12. Wittkowsky AK (2008) Dietary supplements, herbs and oral anticoagulants: the nature of the evidence. J Thromb Thrombolysis 25:72–77

    Article  CAS  PubMed  Google Scholar 

  13. Wittkowsky AK (2001) Drug interactions updates: drugs, herbs and oral anticoagulation. J Thromb Thrombolysis 12:67–71

    Article  CAS  PubMed  Google Scholar 

  14. McAnulty JH (2004) Barriers to the use of warfarin: potential solutions. J Interv Card Electrophysiol 10:17–20

    Article  PubMed  Google Scholar 

  15. Willey ML, Chagan L, Sisca TS, Chapple KJ, Callahan AK, Crain JL, Kitenko LE, Martin T, Spedden KD (2003) A pharmacist-managed anticoagulation clinic: six-year assessment of patient outcomes. Am J Health Syst Pharm 60:1033–1037

    PubMed  Google Scholar 

  16. Davis NJ, Billett HH, Cohen HW, Arnsten JH (2005) Impact of adherence, knowledge, and quality of life on anticoagulation control. Ann Pharmacother 39(4):632–636

    Article  PubMed  Google Scholar 

  17. Krittathanmakul S, Silapachote P, Pongwecharak J, Wongsatit U (2006) Effects of pharmacist counseling on outpatients receiving warfarin at Songklanagarind Hospital. Songkla Med J 24(2):93–99

    Google Scholar 

  18. van Walraven C, Jennings A, Oake N, Fergusson D, Forster A (2006) Effect of study setting on anticoagulation control: a systematic review and metaregression. Chest 129:1155–1166

    Article  PubMed  Google Scholar 

  19. Cios DA, Baker WL, Sander SD, Phung OJ, Coleman CI (2009) Evaluating the impact of study-level factors on warfarin control in U.S.-based primary studies: A meta-analysis. Am J Health Syst Pharm 66:916–925

    Article  PubMed  Google Scholar 

  20. Baker WL, Cios DA, Sander SD, Coleman CI (2009) Meta-analysis to assess the quality of warfarin control in atrial fibrillation patients in the United States. J Manag Care Pharm 15(3):244–252

    PubMed  Google Scholar 

  21. Lee YP, Schommer JC (1996) Effect of a pharmacist-managed anticoagulation clinic on warfarin-related hospital readmissions. Am J Health Syst Pharm 53:1580–1583

    CAS  PubMed  Google Scholar 

  22. Mattaya S, Anusornsangiam W, Kanjanasilp J, Klangsang J (2008) Outcome of pharmaceutical care in anticoagulation clinic at Roi-Et hospital, Roi-Et province, Northeastern Thailand. J Sci Technol MSU 27(1):59–67

    Google Scholar 

  23. Biscup-Horn PJ, Streiff MB, Ulbrich TR, Nesbit TW, Shermock KM (2008) Impact of an inpatient anticoagulation management service on clinical outcomes. Ann Pharmacother 42:777–782

    Article  CAS  PubMed  Google Scholar 

  24. Munjamroon Y, Suttajit S, Tammarat T, Saritreechaikun D (2007) Clinical outcomes of warfarin monitoring in outpatients at Nakorn Phanom Hospiatal. J Sci Technol MSU 26(1):38–46

    Google Scholar 

  25. Zed PJ, Filiatrault L (2008) Clinical outcomes and patient satisfaction of a pharmacist-managed, emergency department–based outpatient treatment program for venous thromboembolic disease. CJEM 10(1):10–17

    PubMed  Google Scholar 

  26. Macik BG (2003) The future of anticoagulation clinics. J Thromb Thrombolysis 16:55–59

    Article  PubMed  Google Scholar 

  27. Chan FWH, Wong RSM, Lau W-H, Chan TYK, Cheng G, You JHS (2006) Management of Chinese patients on warfarin therapy in two models of anticoagulation service – a prospective randomized trial. Br J Clin Pharmacol 62(5):601–609

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  28. McMullin ST, Hennenfent JA, Ritchie DJ, Huey WY, Lonergan TP, Schaiff RA, Tonn ME, Bailey TC (1999) A prospective, randomized trial to assess the cost impact of pharmacist-initiated interventions. Arch Intern Med 159:2306–2309

    CAS  PubMed  Google Scholar 

  29. You J, Cheng G, Chan T (2008) Comparison of a clinical pharmacist-managed anticoagulation service with routine medical care: impact on clinical outcomes and health care cost. Hong Kong Med J 14(Suppl 3):S23–S27

    Google Scholar 

  30. Saokaew S, Permsuwan U, Chaiyakunapruk N, Nathisuwan S, Sukonthasarn A (2010) Effectiveness of pharmacist-participated warfarin therapy management: a systematic review and meta-analysis. J Thromb Haemost 8:2418–2427

    Article  CAS  PubMed  Google Scholar 

  31. Saokaew S, Permsuwan U, Chaiyakunapruk N, Nathisuwan S, Sukonthasarn A, Jeanpeerapong N (2013) Cost-effectiveness of pharmacist-participated warfarin therapy management in Thailand. Thromb Res 132(4):437–443

    Article  CAS  PubMed  Google Scholar 

  32. Saokaew S, Sapoo U, Nathisuwan S, Chaiyakunapruk N, Permsuwan U (2012) Anticoagulation control of pharmacist-managed collaborative care versus usual care in Thailand. Int J Clin Pharm 34(1):105–112

    Article  PubMed  Google Scholar 

  33. Chiquette E, Amato MG, Bussey HI (1998) Comparison of an anticoagulation clinic with usual medical care: anticoagulation control, patient outcomes, and health care costs. Arch Intern Med 158:1641–1647

    Article  CAS  PubMed  Google Scholar 

  34. Dager WE, Branch JM, King JH, White RH, Quan RS, Musallam NA, Albertson TE (2000) Optimization of inpatient warfarin therapy: impact of daily consultation by a pharmacist-managed anticoagulation service. Ann Pharmacother 34:567–572

    Article  CAS  PubMed  Google Scholar 

  35. Lodwick AD, Sajbel TA (2000) Patient and physician satisfaction with a pharmacist-managed anticoagulation clinic: implications for managed care organizations. Manag Care 9:47–50

    CAS  PubMed  Google Scholar 

  36. Lalonde L, Martineau J, Blais N, Montigny M, Ginsberg J, Fournier M, Berbiche D, Vanier M-C, Blais L, Perreault S, Rodrigues I (2008) Is long-term pharmacist-managed anticoagulation service efficient? A pragmatic randomized controlled trial. Am Heart J 156:148–154

    Article  PubMed  Google Scholar 

  37. Anderson JL, Horne BD, Stevens SM, Grove AS, Barton S, Nicholas ZP, Kahn SFS, May HT, Samuelson KM, Muhlestein JB, Carlquist JF, for the Couma-Gen Investigators (2007) Randomized trial of genotype-guided versus standard warfarin dosing in patients initiating oral anticoagulation. Circulation 116:2563–2570

    Article  CAS  PubMed  Google Scholar 

  38. Gage B, Eby C, Johnson J, Deych E, Rieder M, Ridker P, Milligan P, Grice G, Lenzini P, Rettie A, Aquilante C, Grosso L, Marsh S, Langaee T, Farnett L, Voora D, Veenstra D, Glynn R, Barrett A, McLeod H (2008) Use of pharmacogenetic and clinical factors to predict the therapeutic dose of warfarin. Clin Pharmacol Ther 84(3):326–331

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  39. Gage BF, Eby C, Milligan PE, Banet GA, Duncan JR, McLeod HL (2004) Use of pharmacogenetics and clinical factors to predict the maintenance dose of warfarin. Thromb Haemost 91:87–94

    CAS  PubMed  Google Scholar 

  40. Millican EA, Lenzini PA, Milligan PE, Grosso L, Eby C, Deych E, Grice G, Clohisy JC, Barrack RL, Burnett RSJ, Voora D, Gatchel S, Tiemeier A, Gage BF (2007) Genetic-based dosing in orthopedic patients beginning warfarin therapy. Blood 110:1511–1515

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  41. Sconce EA, Khan TI, Wynne HA et al (2005) The impact of CYP2C9 and VKORC1 genetic polymorphism and patient characteristics upon warfarin dose requirements: proposal for a new dosing regimen. Blood 106:2329–2333

    Article  CAS  PubMed  Google Scholar 

  42. Takahashi H, Wilkinson GR, Nutescu EA, Morita T, Ritchie MD, Scordo MG, Pengo V, Barban M, Padrini R, Ieiri I, Otsubo K, Kashima T, Kimura S, Kijima S, Echizen H (2006) Different contributions of polymorphisms in VKORC1 and CYP2C9 to intra- and inter-population differences in maintenance dose of warfarin in Japanese, Caucasians and African-Americans. Pharmacogenet Genomics 16:101–110

    Article  CAS  PubMed  Google Scholar 

  43. Tham LS, Goh BC, Nafziger A, Guo JY, Wang LZ, Soong R, Lee SC (2006) A warfarin-dosing model in Asians that uses single-nucleotide polymorphisms in vitamin K epoxide reductase complex and cytochrome P450 2C9. Clin Pharmacol Ther 80:346–355

    Article  CAS  PubMed  Google Scholar 

  44. Voora D, Eby C, Linder MW, Milligan PE, Bukaveckas BL, McLeod HL, Maloney W, Clohisy J, Burnett RS, Grosso L, Gatchel SK, Gage BF (2005) Prospective dosing of warfarin based on cytochrome P-450 2C9 genotype. Thromb Haemost 93:700–705

    CAS  PubMed  Google Scholar 

  45. Wen M-S, Lee M, Chen J-J, Chuang H-P, Lu L-S, Chen C-H, Lee T-H, Kuo C-T, Sun F-M, Chang Y-J, Kuan P-L, Chen Y-F, Charng M-J, Ray C-Y, Wu J-Y, Chen Y-T (2008) Prospective study of warfarin dosage requirements based on CYP2C9 and VKORC1 genotypes. Clin Pharmacol Ther 84(1):83–89

    Article  CAS  PubMed  Google Scholar 

  46. Zhu Y, Shennan M, Reynolds KK, Johnson NA, Herrnberger MR, Valdes R, Linder MW (2007) Estimation of warfarin maintenance dose based on VKORC1 (−1639 G > A) and CYP2C9 Genotypes. Clin Chem 53(7):1199–1205

    Article  CAS  PubMed  Google Scholar 

  47. Bussey HI, Wittkowsky AK, Hylek EM, Walker MB (2008) Genetic testing for warfarin dosing? Not yet ready for prime time. Pharmacotherapy 28(2):141–143

    Article  CAS  PubMed  Google Scholar 

  48. Holbrook A, Schulman S, Witt DM, Vandvik PO, Fish J, Kovacs MJ, Svensson PJ, Veenstra DL, Crowther M, Guyatt GH (2012) Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl):e152S–e184S. doi:10.1378/chest.11-2295, 141/2_suppl/e152S [pii]

    PubMed Central  CAS  PubMed  Google Scholar 

  49. You JJ, Singer DE, Howard PA, Lane DA, Eckman MH, Fang MC, Hylek EM, Schulman S, Go AS, Hughes M, Spencer FA, Manning WJ, Halperin JL, Lip GY (2012) Antithrombotic therapy for atrial fibrillation: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl):e531S–e575S. doi:10.1378/chest.11-2304, 141/2_suppl/e531S [pii]

    PubMed Central  CAS  PubMed  Google Scholar 

  50. Lansberg MG, O’Donnell MJ, Khatri P, Lang ES, Nguyen-Huynh MN, Schwartz NE, Sonnenberg FA, Schulman S, Vandvik PO, Spencer FA, Alonso-Coello P, Guyatt GH, Akl EA (2012) Antithrombotic and thrombolytic therapy for ischemic stroke: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl):e601S–e636S. doi:10.1378/chest.11-2302, 141/2_suppl/e601S [pii]

    PubMed Central  CAS  PubMed  Google Scholar 

  51. Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, Nelson ME, Wells PS, Gould MK, Dentali F, Crowther M, Kahn SR (2012) Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl):e419S–e494S. doi:10.1378/chest.11-2301, 141/2_suppl/e419S [pii]

    PubMed Central  CAS  PubMed  Google Scholar 

  52. Whitlock RP, Sun JC, Fremes SE, Rubens FD, Teoh KH (2012) Antithrombotic and thrombolytic therapy for valvular disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl):e576S–e600S. doi:10.1378/chest.11-2305, 141/2_suppl/e576S [pii]

    PubMed Central  CAS  PubMed  Google Scholar 

  53. Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S, Ortel TL, Pauker SG, Colwell CW Jr (2012) Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl):e278S–e325S. doi:10.1378/chest.11-2404, 141/2_suppl/e278S [pii]

    PubMed Central  CAS  PubMed  Google Scholar 

  54. Olesen JB, Torp-Pedersen C, Hansen ML, Lip GY (2012) The value of the CHA2DS2-VASc score for refining stroke risk stratification in patients with atrial fibrillation with a CHADS2 score 0–1: a nationwide cohort study. Thromb Haemost 107(6):1172–1179. doi:10.1160/TH12-03-0175, 12-03-0175 [pii]

    Article  CAS  PubMed  Google Scholar 

  55. Kamali F, Pirmohamed M (2006) The future prospects of pharmacogenetics in oral anticoagulation therapy. Br J Clin Pharmacol 61(6):746–751

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  56. Gallus A (1999) Towards the safer use of warfarin I: an overview. J Qual Clin Pract 19:55–59

    Article  CAS  PubMed  Google Scholar 

  57. Oden A, Fahlen M (2002) Oral anticoagulation and risk of death: a medical record linkage study. BMJ 325:1073–1075

    Article  PubMed Central  PubMed  Google Scholar 

  58. Merli GJ, Tzanis G (2008) Warfarin: what are the clinical implications of an out-of-range-therapeutic international normalized ratio? J Thromb Thrombolysis. doi:10.1007/s11239-11008-10219-11239

    Google Scholar 

  59. Linkins LA, Choi PT, Douketis JD (2003) Clinical impact of bleeding in patients taking oral anticoagulant therapy for venous thromboembolism: a meta-analysis. Ann Intern Med 139:893–900

    Article  PubMed  Google Scholar 

  60. Steiner T, Rosand J, Diringer M (2006) Intracerebral hemorrhage associated with oral anticoagulant therapy current practices and unresolved questions. Stroke 37:256–262

    Article  CAS  PubMed  Google Scholar 

  61. Fang MC, Chang Y, Hylek EM, Rosand J, Greenberg SM, Go AS, Singer DE (2004) Advanced age, anticoagulation intensity, and risk for intracranial hemorrhage among patients taking warfarin for atrial fibrillation. Ann Intern Med 141:745–752

    Article  PubMed  Google Scholar 

  62. Dauerman HL, Andreou C, Perras MA, Spinner JS, Lessard D, Weiner BH (2000) Predictors of bleeding complications after rescue coronary interventions. J Thromb Thrombolysis 10:83–88

    Article  CAS  PubMed  Google Scholar 

  63. Kuijer PMM, Hutten BA, Prins MH, Buller HR (1999) Prediction of the risk of bleeding during anticoagulant treatment for venous thromboembolism. Arch Intern Med 159:457–460

    Article  CAS  PubMed  Google Scholar 

  64. Libby EN, Garcia DA (2002) A survey of oral vitamin K use by anticoagulation clinics. Arch Intern Med 162:1893–1896

    Article  CAS  PubMed  Google Scholar 

  65. Lindh JD, Holm L, Dahl M-L, Alfredsson L, Rane A (2008) Incidence and predictors of severe bleeding during warfarin treatment. J Thromb Thrombolysis 25:151–159

    Article  CAS  PubMed  Google Scholar 

  66. McMahan DA, Smith DM, Carey MA, Zhou XH (1998) Risk of major hemorrhage for outpatients treated with warfarin. J Gen Intern Med 13:311–316

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  67. Glasheen JJ (2005) Preventing warfarin-related bleeding. Southern Med J 98(1):96–103

    Article  PubMed  Google Scholar 

  68. Beyth RJ, Quinn LM, Landefeld CS (1998) Prospective evaluation of an index for predicting the risk of major bleeding in outpatients treated with warfarin. Am J Med 105:91–99

    Article  CAS  PubMed  Google Scholar 

  69. Ageno W, Gallus AS, Wittkowsky A, Crowther M, Hylek EM, Palareti G (2012) Oral anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141(2 Suppl):e44S–e88S

    PubMed Central  CAS  PubMed  Google Scholar 

  70. Dentali F, Donadini MP, Clark N et al (2011) Brand name versus generic warfarin: a systematic review of the literature. Pharmacotherapy 31(4):386–393

    Article  PubMed  Google Scholar 

  71. Coumadin [package insert] (2011) Bristol-Myers Squibb, Princeton

    Google Scholar 

  72. Horton JD, Bushwick BM (1999) Warfarin therapy: evolving strategies in anticoagulation. Am Fam Physician 59(3):635–646

    CAS  PubMed  Google Scholar 

  73. Knijff-Dutmer EAJ, Van der Palen J, Schut G, Van de Laar MAFJ (2003) The influence of cyclo-oxygenase specificity of nonsteroidal anti-inflammatory drugs on bleeding complications in concomitant coumarine users. Q J Med 96:513–520

    Article  CAS  Google Scholar 

  74. Wittkowsky AK, Bussey HI, Walker MB et al (2007) Dietary supplement use among anticoagulation clinic patients. J Thromb Haemost 5:875–877

    Article  CAS  PubMed  Google Scholar 

  75. Ramsay NA, Kenny MW, Davies G, Patel JP (2005) Complementary and alternative medicine use among patients starting warfarin. Br J Haematol 130:777–780

    Article  PubMed  Google Scholar 

  76. Kotirum S, Chaiyakunapruk N, Jampachaisri K, Wattanasombat S, Rojnuckarin P (2007) Utilization review of concomitant use of potentially interacting drugs in Thai patients using warfarin therapy. Pharmacoepidemiol Drug Saf 16:216–222

    Article  PubMed  Google Scholar 

  77. Russell TM (2011) Warfarin and beyond: an update on oral anticoagulation therapy. US Pharm 36(2):26–43

    Google Scholar 

  78. Wang Y, Kong MC, Ko Y (2013) Comparison of three medication adherence measures in patients taking warfarin. J Thromb Thrombolysis 36:416–421

    Article  CAS  PubMed  Google Scholar 

  79. Morisky DE, Green LW, Levine DM (1986) Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 24(1):67–74

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Muang, Phayao, 56000, Thailand

    Surasak Saokaew BPharm, PharmD, PhD

Authors
  1. Surasak Saokaew BPharm, PharmD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Surasak Saokaew BPharm, PharmD, PhD .

Editor information

Editors and Affiliations

  1. Madison, Wisconsin, USA

    Anne Rose

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Saokaew, S. (2015). Ambulatory Warfarin Management. In: Rose, A. (eds) Anticoagulation Management. Adis, Cham. https://doi.org/10.1007/978-3-319-22602-6_2

Download citation

Publish with us

Policies and ethics

Search

Navigation