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Arch Intern Med. 2003;163:1265-1266.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

ORAL ANTICOAGULATION with a vitamin K (phytonadione) antagonist has always been a problematic therapy. The risk of serious bleeding is substantial (2%-3% yearly) and does not decrease over time. In fact, as patients undergoing long-term therapy age, the bleeding risk increases. The therapeutic effect of oral anticoagulation falls in a narrow range between increased risk of thrombosis when the international normalized ratio (INR) is too low and increased bleeding risk when it is too high.

Because of multiple drug and dietary interactions with vitamin K antagonists, therapy must be frequently monitored and the dose of drug adjusted. Patients must make substantial lifestyle changes to cope with the increased bleeding risk and the need for monitoring. Patients with atrial fibrillation or a mechanical heart valve have a permanent risk of thrombotic stroke, and the bleeding risk and inconvenience of oral anticoagulation must be accepted. However, in patients with venous thromboembolism (VTE), . . . [Full Text of this Article]

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The Incidence of Recurrent Venous Thromboembolism After Treatment With Vitamin K Antagonists in Relation to Time Since First Event: A Meta-analysis
Carlo J. J. van Dongen, Roel Vink, Barbara A. Hutten, Harry R. Büller, and Martin H. Prins
Arch Intern Med. 2003;163(11):1285-1293.
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