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Improving Warfarin Management Within the Medical Home: A Health-System Approach

Anticoagulation clinics have been considered the optimal strategy for warfarin management with demonstrated improved patient outcomes through increased time in therapeutic international normalized ratio (INR) range, decreased critical INR values, and decreased anticoagulation-related adverse events. However, not all health systems are able to support a specialized anticoagulation clinic or may see patient volume exceed available […]

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Impact of Body Mass Index and Genetics on Warfarin Major Bleeding Outcomes in a Community Setting

Several studies have demonstrated an association between body mass index (BMI) and warfarin therapeutic dose, but none evaluated the association of BMI with the clinically important outcome of major bleeding in a community setting. To address this evidence gap, we conducted a case–control study to evaluate the association between BMI and major bleeding risk among […]

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Warfarin and Vascular Calcification

  The vitamin K antagonist, warfarin, is the most commonly prescribed oral anticoagulant. Use of warfarin is associated with an increase in systemic calcification, including in the coronary and peripheral vasculature. This increase in vascular calcification is due to inhibition of the enzyme matrix gamma-carboxyglutamate Gla protein (MGP). MGP is a vitamin K-dependent protein that […]

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Warfarin Dosing Algorithms and the Need for Human Intervention

Dosing algorithms for warfarin incorporate clinical and genetic factors, but human intervention to overrule algorithm-based dosing may occasionally be required. The frequency and reasons for varying from algorithmic warfarin management have not been well studied. Methods We analyzed a prospective cohort of 1015 participants from the Clarification of Optimal Anticoagulation through Genetics trial who were […]

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Nonhealing ulcers

Nonhealing Ulcers

A Surfeit of Possibilities… Precise diagnosis of lower-extremity ulcerations is essential. Management differs so extensively between etiologies that misdiagnosis can lead to fatal outcomes. This was brought to mind when an 89-year-old woman was admitted directly to the hospital for treatment of worsening bilateral lower-extremity ulcerations. She had been transferred from another institution after a […]

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