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Warfarin: Less May Be Better
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
TO THE EDITOR:
In their report on loading doses of warfarin therapy, Harrison and colleagues [1] concluded that a 5-mg loading dose of warfarin produced less excess anticoagulation than a 10-mg loading dose. The authors base this conclusion on the fact that fewer patients in the 5-mg group than in the 10-mg group had an INR greater than 3.0. Because the specific values of the greater-than-3.0 INRs are not given, we do not know whether these elevations are clinically significant. For example, INRs of 3.1, 3.2, or 3.3 could be classified as “excess anticoagulation,” but these elevations are not clinically significant.
The authors also state that more patients in the 10-mg group than patients in the 5-mg group received vitamin K (4 compared with 1). Vitamin K was administered to these patients because their INRs ranged from 4.8 to 9.3. However, none of the patients bled. Many clinicians would not administer vitamin K to such patients, particularly if the INRs were less than 6.0 [2]. Finally, the study began with 49 patients-24 patients receiving the 5-mg dose and 25 patients receiving the 10-mg dose. At the end of the study. 17 patients remained in the 5-mg group and 18 remained in the 10-mg group. What happened to the other 14 patients?
Paul R. Casner, MD, PhD
Texas Tech University Health Sciences Center; El Paso, TX 79905
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
