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We appreciate Ms Howard’s insightful comments on our recently published article in the ARCHIVES.¹ As Ms Howard points out, our group conducted a study of patients treated at our Anticoagulation Service, demonstrating that the increase in INR prior to warfarin-associated hemorrhage is brief and subtle.² Therefore, we encourage more frequent monitoring of the INR, and we recommend adjusting the warfarin dose downward when the INR rises progressively within the designated target range. These goals can be realized by developing critical monitoring pathways within the context of an anticoagulation clinic.³ Patients must also take responsibility, cooperate, and collaborate in their own care.

Inpatient medical errors associated with anticoagulant therapy constitute the fifth most common type of medication error observed in an audit at Brigham and Women’s Hospital, Boston, Mass.⁴ Despite our concerted efforts to prevent bleeding complications, warfarin-associated hemorrhage is increasing over time, not decreasing.⁵ Therefore, we . . . [Full Text of this Article]

AUTHOR INFORMATION
Sophia Koo, MD; Nils Kucher, MD; John Fanikos, MD; Samuel Z. Goldhaber, MD

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