An important paper in Chest reported that levels of anticoagulation are out or range more frequently in community practice than in anticoagulation clinics or clinical trials. This demonstrates once again that drugs are safer in the hands of clinical trialists than in the hands of community physicians. Drug safety is not absolute. It’s all in how they’re used.
The optimal duration of warfarin anticoagulation for venous thromboembolism is controversial, and clinical decisions are often based on the expected annual rate of bleeding. This paper reminds us to be cautious in the interpretation of clinical trial data in estimating this risk.