Background: Warfarin and other anticoagulants increase the risk of hemorrhagic complications, including upper gastrointestinal hemorrhages (UGIB). Warfarin is commonly used in the management of atrial fibrillation to reduce the risk of ischemic stroke, and frequently resumed following UGIB. However, optimal timing of reinitiation remains unclear. Theory suggests that resuming warfarin immediately after UGIB would lead [...]

Background: While anticoagulants are the core treatment plan for preventing strokes in patients with atrial fibrillation and managing patients with thromboembolic disease, there is a dichotomy of efficacy and harm with their use. Rapid inpatient reversal protocols are important for patient safety. Four factor prothrombin complex concentrate (4FPCC) is approved for reversal of warfarin-induced coagulopathy. [...]

Background: Warfarin-associated adverse drug events are dangerous, common, and costly. Anticoagulation safety is a national priority. While multiple tools exist for warfarin management in the outpatient setting, there is a dearth of guidance with regard to inpatient management. This study aims to: 1) describe a health system’s inpatient chronic warfarin quality metrics, defined by International [...]

Background: Warfarin is commonly used in long-term anticoagulation and has a narrow therapeutic index. Dosing is dependent on intrinsic patient variables including cytochrome P450 2C9 (CYP2C9) and VKORC1 polymorphisms. High protein binding and CYP-dependent clearance mechanisms of NSAIDs also affect warfarin serum levels. This study investigates the observed pharmacologic interaction of concurrent NSAID and warfarin [...]

Case Presentation: A 56-year-old female with a history of a deep vein thrombosis (DVT) during pregnancy and dementia presented with dyspnea and acute hypoxemia. Shortly thereafter, she developed persistent fevers and acute encephalopathy. Initial testing, including lumbar puncture, chest x-ray, multiple blood cultures, urine cultures, respiratory cultures, and RPR were all unremarkable. CT head was [...]

Case Presentation: A 62-year-old man presented with 5 weeks of progressive right lower extremity ulceration associated with pain, swelling, erythema, fevers, and diaphoresis. Initially, outpatient providers diagnosed patient with cellulitis following minor trauma and complicated by chronic venous stasis. Medical history included poorly-controlled insulin-dependent type 2 diabetes, atrial fibrillation on warfarin, recurrent venous stasis ulcers, [...]