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Editorials |

Maintaining Therapeutic Anticoagulation : The Importance of Keeping “Within Range”

Deirdre A. Lane, PhD; Gregory Y. H. Lip, MD
Author and Funding Information

Birmingham, UK

Correspondence to: Gregory Y. H. Lip, MD, University Department of Medicine, City Hospital, Birmingham B18 7QH, UK; e-mail: g.y.h.lip@bham.ac.uk



Chest. 2007;131(5):1277-1279. doi:10.1378/chest.07-0273
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Oral anticoagulation (OAC) is widely used in elderly patients for a variety of conditions, including atrial fibrillation (AF), valve replacement, and venous thromboembolism. In AF, OAC therapy has been proven to reduce the risk of all-cause mortality, stroke, and thromboembolic events.1 However, the efficacy of OAC depends on maintenance of the international normalized ratio (INR) within the designated therapeutic range. Indeed, analysis of stroke or systemic embolism event rates in subjects allocated to the OAC arms in the initial primary prevention trials2 found that these events occurred at subtherapeutic INRs, leading to the suggestion that “truly” therapeutic OAC (100% within target INR range) could reduce strokes by ≥ 85% in AF.

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