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2009•Cleveland Clinic Journal of MedicineOpen access

An algorithm for managing warfarin resistance

Olusegun O. Osinbowale, Monzr M. Al Malki, Andrew E. Schade, John R. Bartholomew

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Abstract

Some patients need higher-than-expected doses of warfarin (Coumadin) to get their international normalized ratio (INR) into the therapeutic range. The cause of warfarin resistance can be either acquired (eg, poor compliance, drug interactions, dietary interactions) or hereditary, but the genetic mechanisms of warfarin resistance are not well understood. This review offers an algorithm for the evaluation of patients with suspected warfarin resistance.

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Some patients need higher-than-expected doses of warfarin (Coumadin) to get their international normalized ratio (INR) into the therapeutic range. The cause of warfarin resistance can be either acquired (eg, poor compliance, drug interactions, dietary interactions) or hereditary, but the genetic mechanisms of warfarin resistance are not well understood. This review offers an algorithm for the evaluation of patients with suspected warfarin resistance.

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Available abstract

Some patients need higher-than-expected doses of warfarin (Coumadin) to get their international normalized ratio (INR) into the therapeutic range. The cause of warfarin resistance can be either acquired (eg, poor compliance, drug interactions, dietary interactions) or hereditary, but the genetic mechanisms of warfarin resistance are not well understood. This review offers an algorithm for the evaluation of patients with suspected warfarin resistance.

Key concepts: Warfarin, Medicine, Drug resistance, Intensive care medicine, Compliance (psychology), Drug, Algorithm, Pharmacology

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