In treatment of deep venous thrombosis, when should warfarin be started relative to heparin?

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Multiple Choice

In treatment of deep venous thrombosis, when should warfarin be started relative to heparin?

The important idea is bridging anticoagulation: warfarin needs several days to become therapeutic, so it’s started right away with heparin to provide immediate anticoagulation. Heparin covers the patient while warfarin ramps up. Once the INR is in the therapeutic range for a day or two, heparin can be stopped and warfarin continued alone. Delaying starting warfarin or waiting after initiation of heparin creates a period without adequate anticoagulation, increasing the risk of clot progression.

The important idea is bridging anticoagulation: warfarin needs several days to become therapeutic, so it’s started right away with heparin to provide immediate anticoagulation. Heparin covers the patient while warfarin ramps up. Once the INR is in the therapeutic range for a day or two, heparin can be stopped and warfarin continued alone. Delaying starting warfarin or waiting after initiation of heparin creates a period without adequate anticoagulation, increasing the risk of clot progression.

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