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In their article recently published in the ARCHIVES, Torn and colleagues¹ underscore the importance to establish an optimal therapeutic range for people taking warfarin. Warfarin, in fact, is associated with a high risk of bleeding when the international normalized ratio rises above the upper limits and with a lacking prophylactic effect when it falls under the lower limits of the therapeutic range. To encompass these problems, a strict control performed by experienced personnel in anticoagulant (AC) clinics and the use of computer-assisted dosage adjustment are recommended in the editorial by O’Donnel and Hirsh² in the same ARCHIVES issue.

Although we do not disagree with this position, we believe that the collective relevance of a service is based on much more than a mere technologic intervention. It is known that elderly people currently do not receive adequate AC prophylaxis, although they are at high risk of thromboembolic events.² . . . [Full Text of this Article]

AUTHOR INFORMATION
Giuseppe Bellelli, MD; Renzo Rozzini, MD; Marco Trabucchi, MD

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Lowering the Intensity of Oral Anticoagulant Therapy: Effects on the Risk of Hemorrhage and Thromboembolism
Marieke Torn, Felix J. M. van der Meer, and Frits R. Rosendaal
Arch Intern Med. 2004;164(6):668-673.
ABSTRACT | FULL TEXT