Long-term anticoagulation therapy for thromboembolic diseases has always been an important clinical problem. Although important progress has been made in the research and development of new anticoagulants, which have been or will soon be marketed, warfarin, as the oldest oral anticoagulant, is still the most commonly used drug for patients requiring long-term anticoagulant therapy, including primary and secondary prevention of venous thromboembolic disease (VTE), prevention of atrial fibrillation (AF) thromboembolism, valvular disease, prosthetic valve replacement, and intracardiac thrombosis, etc.[1]。 Warfarin has accumulated a large amount of clinical evidence in the above-mentioned areas, and millions of patients are currently using warfarin worldwide. A meta-analysis of non-valvular atrial fibrillation studies revealed[2]Warfarin reduced the relative risk of stroke by 64% and significantly reduced all-cause mortality by 26%. However, the use rate of warfarin in China is very low, not more than 10% of patients with atrial fibrillation[3]。 The reasons leading to the low clinical treatment rate of warfarin include: narrow therapeutic window, large dose variability, interaction with other drugs and foods, and the need for laboratory monitoring. However, the more important reason is that clinicians often overestimate the bleeding risk of warfarin, and the importance of warfarin anticoagulant effect is insufficient. Because of the special pharmacological properties, the use of warfarin has many particularities. Domestic clinicians have many concerns and misunderstandings about how to apply warfarin, such as how to select indications, balance benefits and risks, dose selection and adjustment, management of abnormally elevated international standardized ratio (INR), and how to deal with practical problems such as combined use of antiplatelet drugs and perioperative management. Therefore, the Cardiovascular Branch of Chinese Medical Association and the Professional Committee of Cardiovascular and Cerebrovascular Diseases of Chinese Gerontological Society organized and formulated this consensus to promote and standardize the use of warfarin and reduce the mortality and disability rate of thromboembolic diseases.
