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Volume 349:1976-1977 November 13, 2003 Number 20
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Long-Term Anticoagulant Therapy

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by Schulman, S.
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To the Editor: Schulman (Aug. 14 issue)1 states that a starting dose of 15 mg of warfarin daily is effective and reduces the duration of heparin treatment. This strategy of giving higher initial doses of warfarin requires clarification. Most studies demonstrating the superiority of higher loading doses have included only outpatients. Inpatients are more sensitive to warfarin therapy because of poor dietary status and the concomitant use of broad-spectrum antibiotics that decrease vitamin K absorption from enteric flora. Studies have shown both that because inpatients are more sensitive to warfarin, they do not require a higher loading dose2 and that . . . [Full Text of this Article]



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