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Novel Anticoagulants: Evidence-Based Patient Selection

Novel Anticoagulants: Evidence-Based Patient Selection

Mrs. Jones, a 76-year-old woman with permanent atrial fibrillation (AF), hypertension, diabetes, diastolic dysfunction, and osteoarthritis presents to your clinic for follow-up. She has difficulty walking because of her arthritis and uses a walker for support. She has no history of falls or of stroke or transient ischemic attack.  She has never had significant bleeding but uses a proton pump inhibitor for gastrointestinal reflux disorder. On her most recent chemistry screen, her renal function was normal.

Mrs. Jones is currently being treated with warfarin but she is frequently unable to get to her appointments to have her INR checked. Based on the last 6 months of INR readings, she tends to be within therapeutic range approximately 50% of the time. You are concerned about her inability to maintain regular follow-up for her INR and about her low time in therapeutic range (TTR).

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