Warfarin is one of the most common anticoagulants in current use. It maintains a narrow therapeutic index resulting in a significant amount of bleeding. Changes in concomitant medication use and acute illnesses are common causes of overanticoagulation. Monitoring regimens based on patient characteristics and the intensity and duration of anticoagulant therapy, along with simple prediction rules, can reduce the risk of warfarin-related bleeding. Supratherapeutic international normalized ratios are usually best treated by holding a dose and/or reducing the weekly dose of warfarin. Patients with acute bleeding require more urgent warfarin reversal.
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