• Gregory C. Hadlock
  • Allison E. Burnett
  • Edith A. Nutescu


Until recently, vitamin K antagonists, such as warfarin, were the only oral anticoagulants available for long-term or extended anticoagulation. Although very effective for prevention and treatment of venous and arterial thromboembolism, warfarin has a narrow therapeutic index, many drug, disease, and dietary interactions, and requires frequent monitoring and dose adjustments (Ageno et al., Chest 141(2 Suppl):e44S–88S, 2012; Holbrook et al., Chest 141(2 Suppl):e152S–84S, 2012; Nutescu et al., J Thromb Thrombolysis 42(2):296–311, 2016; Witt et al., J Thromb Thrombolysis 41:187–205, 2016). These drawbacks have historically resulted in under treatment of patients that warrant anticoagulation therapy (Ogilvie et al., Am J Med. 123(7):638–645.e4, 2010). While direct oral anticoagulants (DOACs) have significantly changed approaches to anticoagulation therapy, are more convenient and are easier to use, warfarin will continue to be a mainstay of therapy for many patients. Thus, clinicians must possess familiarity with this still widely used medication. In this chapter, we will discuss the pharmacology, clinical utility, and practical management aspects that promote optimized safety and efficacy of warfarin therapy.


Anticoagulation Atrial fibrillation Cardiac valve Direct oral anticoagulant International normalized ratio Prothrombin complex concentrate Venous thromboembolism Vitamin K Warfarin 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Gregory C. Hadlock
    • 1
  • Allison E. Burnett
    • 2
  • Edith A. Nutescu
    • 3
  1. 1.Inpatient Pharmacy DepartmentUniversity of New Mexico HospitalAlbuquerqueUSA
  2. 2.University of New Mexico College of PharmacyAlbuquerqueUSA
  3. 3.Department of Pharmacy Systems, Outcomes and Policy, Center for Pharmacoepidemiology and Pharmacoeconomic ResearchThe University of Illinois at Chicago College of PharmacyChicagoUSA

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