What approach supports safe warfarin dose adjustments?

• A. Random adjustments
• B. Protocol-driven adjustments
• C. Based on physician mood
• D. After adverse events

Answer: (B)

Managing warfarin safely relies on a standardized, protocol-driven approach that uses INR results to adjust dosing in a predictable, evidence-based way. Warfarin has a narrow therapeutic window and many drug–food interactions, so dose changes must follow pre-defined rules rather than guesswork. Protocol-driven adjustments specify how much to increase or decrease the next dose based on the current INR and the target range, reducing variability between clinicians and preventing both under-anticoagulation and over-anticoagulation. This approach also makes monitoring and adjustments transparent and consistent across different providers. In contrast, random adjustments lack safety checks, basing changes on mood is not evidence-based, and waiting for adverse events is reactive and misses opportunities to prevent harm.