This quasi-experimental pre–post interventional study evaluated the effect of a structured health education program on patients’ knowledge and practice related to warfarin therapy in River Nile State, Sudan, during 2024–2025. Adult outpatients receiving warfarin for at least one month were enrolled using consecutive sampling and assessed before and after the intervention. A total of 150 participants completed both assessments. Data were collected using a structured interviewer-administered questionnaire covering key knowledge domains (indications, adherence, drug and food interactions, adverse effects, missed-dose management, and monitoring requirements) and self-reported practice behaviors. The intervention consisted of standardized face-to-face educational sessions supported by printed materials. Changes in knowledge and practice scores were analyzed using appropriate paired statistical tests. At baseline, most participants demonstrated poor warfarin-related knowledge despite high self- reported adherence. Following the educational intervention, there was a marked improvement across nearly all knowledge domains, with the mean knowledge score more than doubling and the majority of participants transitioning to a good knowledge category. Improvements were particularly notable in awareness of drug and food interactions, recognition of warning signs, and appropriate management of missed doses. Self-reported adherence remained high before and after the intervention, suggesting a ceiling effect. Overall, the study demonstrates that a brief, structured educational intervention is a feasible and effective approach to substantially improving warfarin-related knowledge in a low-resource outpatient setting, highlighting the importance of integrating patient education into routine anticoagulation care to enhance medication safety.

Patient self-testing (PST) for warfarin management is well-established in developed countries but remains underused in developing regions. This study compared the safety and effectiveness of PST with usual care (UC) in China. A multicentre, open-label, randomised, controlled trial. A total of five centres participated in this study, including one provincial tertiary hospital, two municipal tertiary hospitals and two primary hospitals. Patients undergoing mechanical heart valve (MHV) replacement at five centres were prospectively enrolled. Patients were trained and stratified according to time on warfarin at enrolment and were randomly assigned to the PST or UC group. The PST group used a point-of-care testing device for at-home international normalised ratio (INR) monitoring with pharmacist-guided warfarin dosing, while the UC group attended outpatient clinics for INR monitoring and dosing. The primary outcome was the difference in time in therapeutic range (TTR). The secondary outcomes were incidences of major bleeding, thromboembolism and all-cause deaths in 12 months. From March 2021 to March 2023, a total of 556 patients were enrolled, with a mean age of 47.5 years, 45.1% being male. 342 were newly initiating warfarin therapy, while 214 had been on warfarin for over 6 months. Baseline characteristics were similar between the PST and UC groups. The PST group showed significantly higher TTR (67.2% vs 55.1%, p<0.001) and lower incidences of major bleeding (0.7% vs 7.9%, p<0.001) and thromboembolism (0.4% vs 6.8%, p<0.001), with no difference in all-cause mortality (0.4% vs 1.8%, p=0.22). Logistic regression identified that using PST and younger age were independent factors associated with fewer warfarin-related adverse events. A pharmacist-led PST intervention with ongoing education and counselling led to improved TTR and clinical outcomes in patients with MHV in China. China Clinical Trial Registry (ChiCTR2000038984).

To develop and validate a multidimensional tool to assess adherence to warfarin therapy by Brazilian patients. A Tool for Assessing Adherence to Warfarin Therapy (TAAW) was designed to encompass warfarin intake and other treatment-related aspects, including causal and effect items of adherence. The development process included: (i) construction of a concept map; (ii) elaboration of a preliminary version; (iii) expert assessment; (iv) semantic analysis through pre-testing with 30 participants; and (v) psychometric validation, including exploratory factor analysis, internal consistency, test-retest reliability and hypothesis testing. Of the 35 initially drafted items, 14 were discarded and 19 modified, resulting in a final version with 21 items distributed across three dimensions: warfarin intake (n = 10), self-care associated with warfarin use (n = 7) and health monitoring (n = 4). The TAAW tool demonstrated a unidimensional structure, excellent internal consistency (Cronbach's alpha = 0.98), high test-retest reliability (Intraclass Correlation Coefficient = 0.96) and strong correlation with the time in therapeutic range (Spearman's rho = 0.91), confirming its validity and reliability. The validated TAAW is a robust instrument for assessing adherence to warfarin therapy in clinical and research settings. Its comprehensive approach allows for the identification of adherence patterns, enabling healthcare professionals to implement targeted interventions and optimize anticoagulation outcomes.

A woman in her 20s with a mechanical mitral valve replacement on long-term warfarin therapy presented with frank haematuria and acute kidney injury (AKI). The initial clinical impression was anticoagulant-related nephropathy. However, due to the persistence of urinary abnormalities, further evaluation was undertaken. Renal biopsy revealed immunoglobulin A nephropathy with lambda light chain predominance, raising concern for an underlying monoclonal gammopathy. The patient was managed conservatively with antiproteinuric therapy alone, without immunosuppression, and demonstrated favourable renal recovery. This case highlights the diagnostic importance of renal biopsy and thorough clinical reassessment in patients with haematuria and AKI, particularly in the context of anticoagulation.

Lifelong anticoagulation monitoring is essential for mechanical heart valve recipients. While conventional hospital-based monitoring creates significant patient and system burdens, combining mobile remote monitoring (MRM) with point-of-care testing (POCT) may provide a more efficient solution. This study evaluated whether MRM + POCT enhances warfarin therapy quality and patient outcomes. This study compared conventional anticoagulation management versus MRM + POCT in 148 post-valve replacement patients (74 per group). The conventional cohort underwent standard in-hospital testing and received anticoagulation management guidance from outpatient clinic physicians. In contrast, the MRM + POCT group utilized POCT for self-monitoring, with anticoagulation therapy guided remotely by physicians via the MRM system. We assessed prothrombin time/international normalized ratio values, time to therapeutic anticoagulation, time in the therapeutic range, costs, complications, and satisfaction over 12 months. Compared with conventional anticoagulation management, MRM + POCT resulted in superior outcomes: Faster therapeutic anticoagulation (P < .01), a greater time in the therapeutic range (P < .05), fewer complications (P < .05), lower costs (P < .01), and better satisfaction (P < .01), demonstrating improved clinical and patient-centered outcomes. Additionally, both clinicians and patients found the integrated system user-friendly, easy to master, and expressed a strong intention to continue its use. MRM + POCT optimizes warfarin therapy by improving efficacy, safety, and cost-effectiveness while enhancing patient outcomes, supporting its implementation as standard care for remote anticoagulation management.

ABSTRACT Background: Thrombotic diseases are a global challenge. Warfarin remains the anticoagulant of choice in low- and middle-income countries. In 2017, a study reported suboptimal anticoagulation control of 29.4%, compared to the target of ≥ 65%, in patients who attended the Windhoek Central Hospital’s warfarin clinic. Objective: Factors contributing to the suboptimal anticoagulation control had to be explored. Methods: To achieve this, 72 patients from the interventional cohort at the clinic were interviewed. Results: The majority (39%) of respondents had dosage-related factors, followed by 21% with diet-related factors, 19% reported factors associated with social determinants of health, and the least (5.6%) due to drug interactions in patients with a co-diagnosis of tuberculosis. Conclusion: The study highlighted the need for improved healthcare system support, such as equipping non-physician health cadres (pharmacists and nurses) with the ability to prescribe warfarin therapy and roll out point-of-care testing for patients with limited access to primary healthcare settings, improving access to medication at the primary healthcare facilities, and patient education to improve warfarin therapy outcomes.

Congenital protein C (PC) deficiency is a major thrombotic risk factor in the Japanese population that often leads to severe thrombosis and bleeding in the neonatal period. Treatment typically involves anticoagulation such as warfarin and heparin, with PC concentrates used in acute cases. Here we report the case of a 25-year-old woman diagnosed with severe congenital PC deficiency. She had recurrent episodes of purpura fulminans despite warfarin therapy. After a COVID-19 infection, she developed coagulopathy with poorly controlled thrombotic and bleeding complications, followed by DIC. Replacement therapy with protein C concentrate led to rapid improvement in DIC, thrombosis, and bleeding. The patient will continue warfarin, and regular replacement therapy with protein C concentrate is also planned. This case highlights the potential benefits of new treatment options for severe PC deficiency and underscores the importance of early and appropriate intervention in managing this rare but potentially life-threatening condition.

Objectives: This study investigated the impact of COVID-19 lockdown measures on Time in Therapeutic Range (TTR) for patients receiving warfarin therapy. Methods: A retrospective cohort study was conducted at a tertiary care hospital in Malatya. Patients receiving warfarin for at least one year before and after March 11th, 2020 (the start of pandemic) were included (n=112). Demographic data, comorbidities, medications, and International Normalized Ratio (INR) results were collected. TTR was calculated using the Rosendaal method. Results: The mean TTR before the pandemic was 56.91%, significantly higher than the 40.23% observed during the pandemic (P&amp;lt;0.001). INR measurement intervals also increased significantly during the pandemic (34.2 days pre-pandemic vs. 50.9 days during the pandemic, P&amp;lt;0.001). This effect was most pronounced in patients over 65 years old (P&amp;lt;0.001). Conclusions: COVID-19 lockdown measures significantly decreased TTR and extended INR monitoring intervals for warfarin users. These findings were particularly concerning in the elderly population. Strategies to ensure optimal warfarin monitoring during pandemics or disasters are crucial to prevent complications.

Rationale:Stroke prevention in patients with non-valvular atrial fibrillation who cannot tolerate long-term anticoagulation remains a major clinical challenge. Left atrial appendage occlusion (LAAO) offers an alternative strategy to reduce thromboembolic risk, but device-related thrombus (DRT) formation can undermine its protective benefit. Although most DRT occur early, late thrombus formation related to minimal peri-device leak (PDL) is increasingly recognized. Understanding this rare but serious complication is crucial for optimizing long-term post-LAAO management.Patient concerns:A 65-year-old male with prior ischemic stroke presented to the emergency department 10 months after LAAO with acute dizziness but no neurological deficits.Diagnoses:Transesophageal echocardiography and cardiac computed tomography angiography revealed a large thrombus (3.8 × 2.4 cm) on the Watchman device with minimal PDL, consistent with massive late DRT.Interventions:The patient was started on high-intensity warfarin therapy (international normalized ratio: 2.5–3.5) for anticoagulation. Clopidogrel was temporarily discontinued to reduce bleeding risk.Outcomes:After 2 months of warfarin therapy, repeat cardiac imaging confirmed complete thrombus resolution. The patient remained neurologically intact without embolic complications.Lessons:Even minimal PDL can serve as a nidus for significant late thrombus formation, particularly in patients with interrupted anticoagulation. This case highlights the importance of continued long-term imaging surveillance after LAAO and individualized anticoagulation strategies. Clinicians should maintain vigilance for late DRT, especially in high-risk patients, and consider extended follow-up protocols to optimize outcomes.

Warfarin, a classic oral anticoagulant, is characterized by a narrow therapeutic window and considerable interindividual variability in dosing requirements. This makes precise dose adjustment challenging in clinical practice and increases the risk of bleeding or thrombosis. To improve dose prediction, this study developed a streamlined multilayer perceptron (MLP) model using real-world data from the International Warfarin Pharmacogenomics Consortium (IWPC) database. The LASSO-proj algorithm was applied for high-precision feature selection prior to model construction. The resulting model demonstrated strong predictive performance on the test set, achieving a coefficient of determination ( R 2) of 0.456, a mean absolute error (MAE) of 8.92 mg/week, and 48.522% of its predictions falling within ±20% of the actual stable therapeutic dose. Through SHAP-based interpretation using DeepExplainer, key features influencing warfarin dosing were identified, including the VKORC1 genotype, body weight, age, and ethnicity. The interpretable MLP framework incorporating LASSO-proj not only maintains high predictive accuracy, but also significantly enhances model transparency, providing a valuable tool for guiding warfarin therapy.

Patient: Female, 28-year-oldFinal Diagnosis: Hemoperitoneum • ovarian cystSymptoms: Nausea • severe pelvic pain • vertigoClinical Procedure: —Specialty: Hematology • General and Internal Medicine • Obstetrics and GynecologyObjective: Rare coexistence of disease or pathologyBackgroundHemoperitoneum resulting from a ruptured ovarian cyst is rare but potentially life-threatening, particularly in patients with underlying coagulopathies. Antiphospholipid syndrome (APS) and hereditary antithrombin III (AT III) deficiency represent an exceptionally uncommon concurrent combination. Only 3 prior cases have been documented in the literature regarding thrombotic events; however, none have described acute hemorrhagic complications or their management.Case ReportA 28-year-old woman presented with a 24-h history of intractable pelvic pain rated 8/10, accompanied by hypotension, tachycardia, and anemia. She had a history of double-positive APS and hereditary AT III deficiency; she was receiving prophylactic warfarin therapy. Imaging revealed a ruptured hemorrhagic ovarian cyst and moderate hemoperitoneum. Initial management included hemodynamic stabilization, fluid resuscitation, and transfusion of red blood cells and fresh frozen plasma. Anticoagulation was withheld, and a computed tomography-guided pigtail catheter was inserted for pelvic hematoma decompression. After stabilization and confirmation of hemostasis, warfarin therapy was cautiously reinitiated under close international normalized ratio (INR) monitoring. The patient achieved complete clinical recovery and was discharged in stable condition.ConclusionsWe present the first documented case of severe hemoperitoneum due to a ruptured ovarian cyst in a patient with concurrent APS and AT III deficiency. This case highlights the complex clinical balance between anticoagulation reversal and thromboprophylaxis in patients with dual hypercoagulable disorders. Future research should aim to develop standardized, evidence-based protocols to guide management and improve outcomes in combined thrombophilic conditions.

PurposeWarfarin is usually used in a fixed loading dose regimen, which may increase the risk of bleeding or prolong the time to reach standard dose. The aim of the study is to compare the efficacy and safety of loading dose versus maintenance dose of warfarin therapy in postpartum women with pulmonary embolism (PE) under the guidance of clinical pharmacogenetic information.Patients and MethodsA total of 64 postpartum women with PE were recruited from September 2022 to August 2023. Participants were randomly divided 1:1 into two groups using a random-number table patients in the experimental group received a regimen combining the initial 1 to 3 days loading dose with the International Warfarin Pharmacogenetics Consortium (IWPC) model. Patients in the control group only received a regimen guided by the IWPC model for the initial 1 to 3 days. Starting from day 4, the warfarin dose was adjusted according to the international normalized ratio (INR). The primary outcome was first time to therapeutic INR (2.0–3.0).ResultsThe study found that the median time to first reach the therapeutic INR was 5.5 days in the experimental group compared to 7 days in the control group (p=0.002). The median time within therapeutic range (TTR) was 97.24% in the experimental group compared to 95.50% in the control group (p=0.001). The difference in adverse events showed no statistical significance between the two groups (P > 0.05).ConclusionThe study could provide ideas for the precise treatment of warfarin in postpartum women with PE. The integration of warfarin loading doses guided by pharmacogenetics into clinical practice can enhance decision-making, optimize patient outcomes, and reduce adverse events.

Introduction: Atrial fibrillation (AF) and tobacco smoking represent two of the most significant and concurrent global health burdens. While smoking is an established risk factor for the development of incident AF, its prognostic impact following an AF diagnosis has remained controversial, particularly regarding thromboembolic risk (Zhu, Guo, &amp; Hong, 2016). This systematic review synthesizes the evidence on the association between smoking status (current, former, and cessation) and a comprehensive range of adverse outcomes in patients with established AF. Methods: A systematic review was conducted adhering to PRISMA guidelines. The Cochrane Library, PubMed, and Embase databases were searched for observational studies (cohort or case-control) and meta-analyses evaluating the prognostic impact of smoking in patients with a confirmed AF diagnosis. Methodological quality and risk of bias for all included non-randomized studies were rigorously assessed using the 9-star Newcastle-Ottawa Scale (NOS) (Wells et al., 2000). Results: A total of 17 high-quality observational studies, including large national cohorts and one key meta-analysis, were included. The evidence was consistent and significant that persistent smoking is associated with increased all-cause mortality (Relative Risk 1.82, 95% CI 1.33–2.49) (Zhu, Guo, &amp; Hong, 2016) and cardiovascular death (RR 1.54, 95% CI 1.31–1.81) (Zhu, Guo, &amp; Hong, 2016). Smoking was also a significant predictor of major bleeding (RR 1.93, 95% CI 1.08–3.47) (Zhu, Guo, &amp; Hong, 2016) and AF recurrence post-catheter ablation (RR 3.19, 95% CI 1.23–8.27) (Okutucu et al., 2010). The association with stroke was contradictory (the "stroke paradox"); a major meta-analysis found no significant link (RR 1.19, 95% CI 0.97–1.46) (Zhu, Guo, &amp; Hong, 2016), while large cohort studies, particularly those in Vitamin K Antagonist (VKA)-treated populations, reported a significant risk (Adjusted Hazard Ratio 1.64–1.66) (Lee et al., 2021; Nakagawa et al., 2015). Critically, smoking cessation after AF diagnosis was associated with a rapid and significant risk reduction for ischemic stroke (aHR 0.702, 95% CI 0.595–0.827) and all-cause death (aHR 0.842, 95% CI 0.748–0.948) compared to persistent smokers (Lee et al., 2021). Discussion: The data confirm that persistent smoking is a major driver of mortality, major bleeding, and interventional failure in AF patients. The "stroke paradox" is likely not a true null effect but a signal of confounding, specifically an interaction with VKA (e.g., warfarin) therapy, where smoking is known to disrupt anticoagulation control (Nakagawa et al., 2015). This risk may be attenuated in the modern era of Direct Oral Anticoagulants (DOACs). Conclusion: Persistent smoking is unequivocally associated with a severe adverse prognostic profile in patients with AF. Smoking cessation provides a rapid, substantial, and quantifiable prognostic benefit—reducing stroke and mortality risk—and must be considered a critical, non-negotiable therapeutic intervention on par with anticoagulation and rhythm control.

Vitamin K antagonists (VKAs), particularly warfarin, remain widely used in Colombia despite the availability of direct oral anticoagulants. Their narrow therapeutic index and variability in response require intensive INR monitoring and close surveillance. Administration of vitamin K1 (phytomenadione) is an essential tool to reverse over-anticoagulation and can also serve as a pharmacotherapeutic “trigger strategy” to identify high-risk patients. This study aimed to characterize a sub-cohort of patients exposed to vitamin K, focusing on clinical, pharmacological, and demographic factors, and to highlight opportunities for clinical pharmacist intervention. An observational, retrospective, and cross-sectional study was conducted within an institutional outpatient–inpatient anticoagulation program in Bogotá, Colombia. From a cohort of 752 anticoagulated patients, a sub-cohort of 52 patients who received vitamin K between March 2024 and February 2025 was identified. Inclusion criteria were adults (≥18 years) with ≥6 months of warfarin therapy; exclusions were dialysis and pregnancy. Clinical and pharmaceutical variables included age, hemoglobin (Hb), hematocrit (Hct), estimated glomerular filtration rate (eGFR, Cockcroft–Gault), body mass index (BMI), number of prescribed drugs, and major drug–drug interactions. Descriptive statistics were applied. Among the 52 patients exposed to vitamin K, 39 (75%) were on active VKA therapy and 13 (25%) were not. The overall mean eGFR was 65.0 mL/min, Hb 12.6 g/dL, Hct 38.5%, BMI 25.5 kg/m², and age 64.4 years. Polypharmacy averaged 10.3 drugs per patient, higher in VKA users (10.5 vs. 9.6). Elevated INR values (≥4) were found in 28/39 VKA users (71.8%), while none were reported in the non-VKA group. Patients with VKA exposure showed more drug interactions (2.59 vs. 1.31 per patient), especially in those with INR ≥4. Compared with 700 VKA patients without vitamin K exposure, this subgroup had greater polypharmacy (10.3 vs. 6.4) and more interactions (2.27 vs. 0.9). Vitamin K exposure identifies a high-risk subgroup of anticoagulated patients with greater polypharmacy, interactions, and altered INR values. This supports its role as a pharmacotherapeutic “trigger strategy” for early detection of adverse events and reinforces the importance of clinical pharmacist-led interventions

Abstract Background and Purpose Left ventricular (LV) thrombus can develop in patients with both ischemic and nonischemic cardiomyopathies. Anticoagulation is recommended to reduce the risk of stroke or systemic embolism. However, existing studies on the effectiveness of direct oral anticoagulants (DOACs) for this indication are often contradictory, have small sample sizes, and include limited follow-up periods. Therefore, we aimed to compare the outcomes associated with DOAC use versus Warfarin use for the treatment of LV thrombus in a large patient cohort. Methods We conducted a retrospective cohort analysis of deidentified, aggregate patient data from the TriNetX research network. Adult patients with with echocardiographically diagnosed LV thrombus between 1/2012 and 1/2022 were identified. Patients were divided into two groups based on DOAC or Warfarin use for management of LV thrombus. Following a tight 1:1 propensity score matching for baseline demographics, prescribed medications, comorbidities and baseline hemoglobin, we calculated odds ratios and Cox proportional hazards ratios to compare 30-day and 1-year outcomes. Primary outcome included the composite of all-cause mortality and stroke. Secondary outcomes included stroke, all-cause mortality and significant bleeding (with or without needing transfusion). Results The matched cohort included 1,890 patients with LV thrombus who were started on DOACs or Warfarin (n=945 per group; mean age: 61.9 years; 28% female; 62% White). The composite outcome of all-cause mortality and stroke did not differ significantly between the two groups at 30-days (DOAC: 13.3% vs. Warfarin: 15%; OR: 0.87 [95% CI: 0.67–1.13]; P=0.291) and 1-year (DOAC: 23.8% vs. Warfarin: 26.7%; OR: 0.855 [95% CI: 0.69–1.05]; P=0.138). The 1-year independent risk of stroke also did not differ significantly (DOAC: 13.9% vs. Warfarin: 15.1%; OR: 0.903 [95% CI: 0.70–1.17]; P=0.43) between the two groups as well as the 1-year independent risk of death (DOAC: 11.9% vs. Warfarin: 14.2%; OR: 0.814 [95% CI: 0.62–1.06]; P=0.13). Bleeding risk at 1-year was also comparable in the two groups (DOAC: 4.8% vs. Warfarin: 4.7%; OR: 1.049 [95% CI: 0.68–1.61]; P=0.83).Time-to-event analysis of primary outcomes are depicted in Figure 1. Conclusions In a large cohort of patients with LV thrombus, DOAC therapy was non-inferior to Warfarin therapy with respect to all-cause mortality and stroke, thereby supporting the use of DOACs in this clinical setting.Time to event analysis of outcomes

Background: Warfarin remains essential for preventing thrombosis in patients with mechanical heart valves. However, its narrow therapeutic index and susceptibility to drug interactions demand careful monitoring. We present a case of subacute mechanical aortic valve thrombosis likely precipitated by a warfarin–trazodone interaction. Case Presentation: A 58-year-old man with a history of bicuspid aortic stenosis requiring mechanical valve replacement—previously stable on chronic warfarin therapy (5 mg daily)—presented to the ED with three days of worsening dyspnea, cough, and upper back pain. Upon arrival, he was hypertensive, hypoxic, and in respiratory distress, exhibiting cold extremities, bilateral crackles, and an audible mechanical valve click. Labs revealed an INR of 1.3 (previously therapeutic), lactate 9.0 mmol/L, troponin 233 ng/L, and BNP 6812 pg/mL. CTA showed possible multifocal pneumonia. Initially, he was diagnosed with septic shock and ARDS, requiring vasopressors and BiPAP. Shortly after, he suffered a cardiac arrest, requiring intubation and vasopressor escalation. Transthoracic echocardiography (TTE) revealed a peak gradient of 3.7 m/s and mean gradient of 28 mmHg across the prosthetic valve. Urgent transesophageal echocardiography (TEE) showed severely restricted leaflet motion with torrential aortic regurgitation—highly suggestive of valve thrombosis. Due to prohibitive surgical risk, thrombolysis with alteplase (25 mg over 6 hours) was administered. Repeat TEE demonstrated improved leaflet motion (velocity 2.2 m/s, mean gradient 17.6 mmHg), LVEF of 25%, and new severe mitral regurgitation. He was stabilized on milrinone and extubated by hospital day five. Despite restarting warfarin—at doses up to 30 mg daily (three times his prior regimen)—therapeutic INR was not achieved until 10 days later. Further interrogation revealed, thirteen days prior to ED visit, he was started on trazodone 50 mg. No other interacting medications or hepatic dysfunction were identified. Trazodone was identified as the likely culprit and had been discontinued. His INR subsequently normalized. Discussion: Trazodone may reduce warfarin efficacy, leading to subtherapeutic INR and valve thrombosis in mechanical valve patients. While the exact mechanism is unclear, proposed theories include CYP2C9 induction, increased warfarin clearance, or protein-binding displacement. This case highlights the need for close INR monitoring when initiating trazodone in patients on warfarin.

A propensity-matched analysis of real-world outcomes comparing direct oral anticoagulants and warfarin in patients diagnosed with portal vein thrombosis

Characterization and risk factors of anticoagulation-related bleeding in patients with thrombotic antiphospholipid syndrome: An analysis using a synthetic real-world data platform

Acquired FVIII deficiency in the setting of prior mechanical mitral valve replacement: A delicate balance of competing hemorrhagic and thrombotic risks

Warfarin-induced skin necrosis (WISN) is a rare but serious adverse effect of warfarin that typically occurs during the initial days of therapy. However, late-onset WISN, occurring months or years after stable anticoagulation, is an unusual and poorly understood phenomenon. Here, we present a case of WISN that had presented after 5 years of stable anticoagulation. This research highlights the significance of clinical suspicion, prompt intervention and customised anticoagulation methods for patients on warfarin therapy who present with unexplained necrotic skin lesions.