[Optimizing warfarin treatment].

Abstract

For monitoring of warfarin treatment only analyses with documented International Sensitivity Index should be used. Until further studies clarify the matter, we recommend the therapeutic intervals proposed by the American College of Chest Physicians and the National Heart, Lung, and Blood Institute. For induction of treatment, a daily warfarin dose of 10 mg is useful. Overlapping heparin therapy is recommended for at least five days. Day-to-day variation of dietary vitamin K intake of less than 250-500 micrograms and an alcohol consumption below 47 g/day will not disturb anticoagulation. Bleeding is more common during long-term treatment, among elderly patients and in patients with cerebral arteriosclerotic disease, especially in combination with uncontrolled hypertension. Bleeding patients often have underlying pathology which should be looked for.