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Long-term anticoagulation therapy is important in the management of patients with chronic atrial fibrillation,^1-2 deep vein thrombosis,³ prosthetic heart valves,⁴ and some cases of post–myocardial infarction⁵ because it reduces the incidence of thromboembolic complications and prolongs life.^1-2,5 However, thromboembolism may still occur and, more frequently, hemorrhage may develop as a complication. Indeed, it was not until several trials showed that its advantages outweighed its disadvantages^{1-2,4, 6} that anticoagulation therapy gained widespread acceptance.

Unfortunately, as Ansell⁷ points out in his editorial, the favorable results obtained in published trials are not often reproduced by physicians in their practices. Part of the explanation may be, as Ansell suggests, the imperfect systems of communication that exist between the medical provider, the laboratory, and the patient so that changes in prothrombin activity fail to be translated in timely adjustments of coumadin doses.

An additional reason, in my opinion, is that there is some complacency that places . . . [Full Text of this Article]

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