Evidence-Based Management Of Anticoagulant Therapy

For patients sufficiently healthy to be treated as outpatients, we suggest initiating VKA therapy with warfarin 10 mg daily for the fi rst 2 days followed by dosing based on INR measurements rather than starting with the estimated maintenance dose. (2, C)

For patients initiating VKA therapy, we recommend against the routine use of pharmacogenetic testing for guiding doses of VKA. (1, B)

For patients with acute VTE, we suggest that VKA therapy be started on day 1 or 2 of LMWH or UFH therapy rather than waiting for several days to start. (2, C)