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An article in the August 12/26, 2002, issue of the ARCHIVES compared warfarin with daily subcutaneous low-molecular-weight heparin (LMWH) in the secondary prevention of venous thromboembolism (VTE) in patients with cancer.¹ The authors concluded that the use of warfarin was far more dangerous because of bleeding complications. I submit that it is more likely that the excess bleeding in the warfarin group was caused by allowing the patients' international normalized ratio (INR) to be rated as acceptable up to 3.0. Although this level of anticoagulation has been approved in the general medical community, it is my opinion from 25 years of using warfarin that an INR of 3.0 is far too dangerous. The study in question clearly demonstrates this point in that the INR was only in the "therapeutic" range on 41% of determinations. In addition, most of the serious bleeding occurred when the INR had slipped above 3.0. The . . . [Full Text of this Article]

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