For decades, warfarin (Cou-nadin) has been the gold standard for long-term anti-coagulation in patients at high risk for thromboembolic events (TEEs). The two most common indications for warfarin are prevention of embolic or ischemic stroke in patients with atrial fibrillation (AF) and primary treatment and secondary prevention of TEEs, including deep venous thrombosis (DVT) and pulmonary embolism (PE). Without proper anticoagulation, the risk of TEEs in these patients is high: Those with AF and a CHADS_2 (Congestive heart failure; Hypertension; Age >75 years; Diabetes; prior Stroke, transient ischemic attack, or thromboembolism) score >2 have an estimated risk of 4.5% to 9.6% per year, and those with a history of unprovoked DVT have a 10% risk of recurrence at 1 year and a 30% risk of recurrence at 5 years.1'2 These risks are significant, since a TEE can result in death or permanent disability. Multiple trials have demonstrated that, compared with placebo, warfarin can reduce the risk of death by 25% and that of nonfatal stroke by up to 67% in AF patients.1 In addition, extended therapy (>3 months) has been shown to reduce the risk of recurrent TEEs by 82% in patients with a history of unprovoked DVT or PE.
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