Elaine M. Hylek, MD, MPH; Susan Regan, PhD; Alan S. Go, MD; Robert A. Hughes, MD; Daniel E. Singer, MD; Steven J. Skates, PhD
Acknowledgments: The authors thank Lori Henault, MPH, and Lynn Oertel, RN, for help with data collection; YuChiao Chang, PhD for statistical expertise; and the nurses working in the Anticoagulant Therapy Unit, Massachusetts General Hospital, for their dedication to the care of patients and to the maintenance of a high-quality clinical database.
Grant Support: By Public Health Services research grant AG15478 from the National Institutes of Health and the Eliot B. Shoolman Fund of the Massachusetts General Hospital.
Requests for Single Reprints: Elaine M. Hylek, MD, MPH, General Medicine Division, Clinical Epidemiology Unit, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA 02114.
Current Author Addresses: Drs. Hylek, Regan, and Singer: General Medicine Division, Clinical Epidemiology Unit, Massachusetts General Hospital, 50 Staniford Street, 9th Floor, Boston, MA 02114.
Dr. Hughes: Bulfinch Medical Group, Massachusetts General Hospital, Founders Building, 3rd Floor, 15 Parkman Street, Boston, MA 02114.
Dr. Go: Division of Research, Kaiser Permanente of Northern California, 3505 Broadway Street, 12th Floor, Oakland, CA 94611-5714.
Dr. Skates: Biostatistics Center, Massachusetts General Hospital, 50 Staniford Street, 5th Floor, Boston, MA 02114.
Author Contributions: Conception and design: E.M. Hylek, R.A. Hughes.
Analysis and interpretation of the data: E.M. Hylek, S. Regan, A.S. Go, D.E. Singer, S.J. Skates.
Drafting of the article: E.M. Hylek.
Critical revision of the article for important intellectual content: E.M. Hylek, A.S. Go, R.A. Hughes, D.E. Singer, S.J. Skates.
Final approval of the article: E.M. Hylek, A.S. Go.
Provision of study materials or patients: R.A. Hughes.
Statistical expertise: E.M. Hylek, S. Regan, D.E. Singer, S.J. Skates.
Obtaining of funding: D.E. Singer.
Administrative, technical, or logistic support: R.A. Hughes, D.E. Singer.
Collection and assembly of data: E.M. Hylek, S. Regan, D.E. Singer.
Hylek EM, Regan S, Go AS, Hughes RA, Singer DE, Skates SJ. Clinical Predictors of Prolonged Delay in Return of the International Normalized Ratio to within the Therapeutic Range after Excessive Anticoagulation with Warfarin. Ann Intern Med. 2001;135:393-400. doi: 10.7326/0003-4819-135-6-200109180-00008
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Published: Ann Intern Med. 2001;135(6):393-400.
Warfarin is effective in preventing thromboembolism. Patients taking warfarin often require temporary discontinuation of therapy in preparation for surgery or in response to an episode of excessive anticoagulation. Despite widespread and long-term use of warfarin in clinical practice, few data have been published on the patient-specific factors that influence the rate of normalization of the international normalized ratio (INR) after interruption of warfarin therapy. Published guidelines on preoperative warfarin therapy and management of excessive anticoagulation do not reflect the wide patient variability in the rate of INR decay (1-3).
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