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COMMENTS AND OPINIONS
Factors in Warfarin Therapy Discontinuation—Reply
David Garcia, MD;
Elaine Hylek, MD, MPH
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In reply
Boos and Marshall correctly point out that because a substantial proportion of patients discontinued warfarin therapy 3 or fewer days before their procedure, a residual anticoagulant effect from warfarin could have contributed to some of the bleeding events. Because international normalized ratio values were not routinely recorded on the day of the procedure, we are not able to determine precisely the extent to which this may have been true. The rate of international normalized ratio normalization varies widely among patients and is affected by age, maintenance warfarin dose, and presence of decompensated heart failure.1-2 Among the 23 patients in our study who experienced major or clinically significant bleeding, the duration of the withholding was documented for 17 of them. Twelve (70%) of these patients had warfarin therapy withheld for 4 or more days, and 5 of them had warfarin therapy withheld . . . [Full Text of this Article]
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Risk of Thromboembolism With Short-term Interruption of Warfarin Therapy
David A. Garcia, Susan Regan, Lori E. Henault, Ashish Upadhyay, Jaclyn Baker, Mohamed Othman, and Elaine M. Hylek
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RELATED LETTER
Factors in Warfarin Therapy Discontinuation
Christopher John Boos and Howard J. Marshall
Arch Intern Med. 2008;168(17):1932.
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