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Acetaminophen and Risk Factors for Excess Anticoagulation With Warfarin
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To the Editor.—The article by Dr Hylek et al1 brings a wealth of much-needed information to clinicians managing individual patients (usual clinical practice) and to specialized anticoagulant therapy units. Even though no randomized trial data exist, anticoagulant therapy units seem to improve clinical outcomes and decrease costs.2 Such units provide closer follow-up of patients, focused teaching, dietary management, and detailed review of factors that affect warfarin metabolism. Usual clinical practice may not provide such levels of care.
Could the authors provide additional information on the organization of their unit? Do they use protocols to handle warfarin dosing? Who adjusts the warfarin dose? How frequently is an international normalized ratio (INR) greater than 6 observed? In an evidence-based medicine framework,3 such information will help determine if these findings apply to usual practice. In addition, this information will serve as benchmarks against which other anticoagulation units or individual practitioners may compare . . . [Full Text of this Article]
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