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COUMADIN (Warfarin Sodium) is indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, and pulmonary embolism. COUMADIN is indicated for the prophylaxis and/or treatment of the thromboembolic complications associated with atrial fibrillation and/or cardiac valve replacement. COUMADIN is indicated to reduce the risk of death, recurrent myocardial infarction, and thromboembolic events such as stroke or systemic embolization after myocardial infarction. Dosage and administration The dosage and administration of COUMADIN must be individualized for each patient according to the particular patient's PT/INR response to the drug. The dosage should be adjusted based upon the patient's PT/INR.15,16,17,18,19 The best available information supports the following recommendations for dosing of COUMADIN. Venous Thromboembolism (including deep venous thrombosis [DVT] and pulmonary embolism [PE]) For patients with a first episode of DVT or PE secondary to a transient (reversible) risk factor, treatment with warfarin for 3 months is recommended. For patients with a first episode of idiopathic DVT or PE, warfarin is recommended for at least 6 to 12 months. For patients with two or more episodes of documented DVT or PE, indefinite treatment with warfarin is suggested. For patients with a first episode of DVT or PE who have documented antiphospholipid antibodies or who have two or more thrombophilic conditions, treatment for 12 months is recommended and indefinite therapy is suggested. For patients with a first episode of DVT or PE who have documented deficiency of antithrombin, deficiency of Protein C or Protein S, or the Factor V Leiden or prothrombin 20210 gene mutation, homocystinemia, or high Factor VIII levels ( > 90th percentile of normal), treatment for 6 to 12 months is recommended and indefinite therapy is suggested for idiopathic thrombosis. The risk-benefit should be reassessed periodically in patients who receive indefinite anticoagulant treatment.12,20 The dose of warfarin should be adjusted to maintain a target INR of 2.5 (INR range, 2.0-3.0) for all treatment durations. These recommendations are supported by the American College of Chest Physicians' (7th ACCP) guidelines.15,17,21,22