Is the Dose of Warfarin Prescribed by American Physicians Unnecessarily High?

The proceedings of a national conference on antithrombotic therapy (anticoagulant therapy and platelet-suppressive therapy) sponsored by the American College of Chest Physicians (ACCP) and the National Heart, Lung, and Blood Institute (NHLBI) were published in a special supplement of Chest,1 and the recommendations of the proceedings were summarized in the Archives.2 The recommendations relating to dosage and laboratory monitoring of oral anticoagulants (vitamin K antagonists) imply that for more than two decades many patients in North America could have been treated as effectively but more safely by using lower doses of oral anticoagulants. Because of the far-reaching implications of these recommendations, a follow-up meeting was convened (by one of the chairmen of the ACCP/NHLBI committee) to obtain the impressions of a wide spectrum of interested physicians representing hematology, clinical pathology, pathology, neurology, respiratory medicine, cardiology, clinical epidemiology, surgery, vascular surgery, orthopedic surgery, and industry. The ad hoc working