UMEM Educational Pearls

Category: Toxicology

Title: Warfarin management of ED patients

Keywords: warfarin, INR (PubMed Search)

Posted: 11/29/2011 by Bryan Hayes, PharmD (Emailed: 12/8/2011) (Updated: 12/8/2011)
Click here to contact Bryan Hayes, PharmD

A recent study highlighted the challenges we face managing ED patients on warfarin therapy. Some key observations about how we're doing: 

  • Only 71% of patients on warfarin had an INR checked
  • Nontherapeutic INRs were recorded for 49%; ED providers intervened to address these results in 21% of cases
  • 71% of patients with a supratherapeutic INR received an intervention compared with 9% of patients with a subtherapeutic INR
  • 30% of patients received or were prescribed potentially interacting medications
  • Recommendations for specific anticoagulation follow-up were documented for only 19% of all patients

Literature continues to show warfarin is the most dangerous medication for our patients. Meticulous monitoring and follow up will help us potentially avoid serious interactions and adverse events.


Meeker E, et al. ED management of patients on warfarin therapy. Ann Emerg Med 2011;58:192-99.