{
  "abstract": "Warfarin is one of the most enduring drugs in cardiovascular medicine. Although direct oral anticoagulants (DOACs) have transformed anticoagulation, especially in atrial fibrillation (AF) eligible for DOAC therapy, their success cannot be extrapolated to every thrombotic substrate. This review examines the contemporary boundaries of warfarin and vitamin K antagonist (VKA) therapy. Mechanical heart valves remain the clearest setting in which lifelong international normalized ratio (INR)-guided VKA therapy is required; randomized attempts to substitute dabigatran or apixaban have failed. In rheumatic heart disease-associated AF, INVICTUS favored VKA therapy over rivaroxaban, supporting the VKA class rather than warfarin specifically. High-risk thrombotic antiphospholipid syndrome, particularly triple-positive disease, is another VKA-preferred setting. Left ventricular thrombus (LVT) occupies an evolving position in which warfarin remains established, while randomized evidence supports rivaroxaban as a potential alternative in selected acute post-myocardial infarction LVT. Pregnancy with mechanical valves requires dynamic maternal–fetal risk balancing, whereas advanced chronic kidney disease and dialysis represent areas of uncertainty rather than intrinsic indications for warfarin. The global relevance of warfarin also depends on total anticoagulation burden, including INR monitoring, travel, treatment continuity, quality of anticoagulation, and reversal capacity. The persistence of VKA efficacy in selected highly thrombogenic environments raises a biologically plausible hypothesis that broader suppression of vitamin K-dependent factors may matter, but this mechanism is not established by clinical trials. Contemporary anticoagulation should therefore be substrate-centered: VKA therapy remains necessary in some conditions, preferred in others, increasingly replaceable in several, and uncertain in a few.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Medicine, Hypertensive Heart Disease and Anticoagulation Sectors, Paulista School of Medicine, Federal University of Sao Paulo, Brazil",
    "Department of Medicine, Coronary Artery Disease and Anticoagulation Sectors, Paulista School of Medicine, Federal University of Sao Paulo, Brazil",
    "Department of Medicine, Hypertensive Heart Disease Sector, Paulista School of Medicine, Federal University of Sao Paulo, Brazil",
    "Department of Medicine, Cardiomyopathy and Heart Transplant Sectors, Paulista School of Medicine, Federal University of Sao Paulo, Brazil",
    "Department of Medicine, Valvular Heart Disease and Echocardiography Sectors, Paulista School of Medicine, Federal University of Sao Paulo, Brazil",
    "Department of Medicine, Electrocardiography Sector, Paulista School of Medicine, Federal University of Sao Paulo, Brazil",
    "Department of Medicine, Coronary Artery Disease Sector, Heart Institute, Medicine School, University of Sao Paulo, Brazil"
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 8,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Weverton Ferreira Leite",
      "orcid": "0000-0001-8042-111X"
    },
    {
      "affs": [
        1
      ],
      "name": "Wilma Noia Ribeiro"
    },
    {
      "affs": [
        2
      ],
      "name": "Rui Manuel dos Santos Povoa"
    },
    {
      "affs": [
        3
      ],
      "name": "Dirceu Rodrigues de Almeida"
    },
    {
      "affs": [
        4
      ],
      "name": "Daniela Fernanda Alli Hemerly"
    },
    {
      "affs": [
        5
      ],
      "name": "Braulio Luna Filho"
    },
    {
      "affs": [
        4
      ],
      "name": "Valdir Ambrosio Moises"
    },
    {
      "affs": [
        6
      ],
      "name": "Jose Antonio Franchini Ramires"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/8q3rrrtgmrk4b.bib",
  "cited_by": 0,
  "doi": "10.14740/cr2322",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13719647/?tool=EBI",
  "id": "8q3rrrtgmrk4b",
  "issns": [
    "1923-2829",
    "1923-2837"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13719647",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Review"
    ],
    [
      "openalex",
      "2705|Atrial Fibrillation Management and Outcomes"
    ]
  ],
  "openalex": "W7223466745",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13719647/pdf/?tool=EBI",
  "pmcid": "PMC13719647",
  "pmid": "42964437",
  "published": "2026-10-24",
  "publisher": "Elmer Press",
  "ris": "https://research.draconitic.com/paper/8q3rrrtgmrk4b.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T12:21:37Z",
      "native_id": "PMC:PMC13719647",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13719647"
    },
    {
      "first_seen": "2026-11-02T12:23:34Z",
      "native_id": "PMC13719647",
      "source": "pmc",
      "url": "https://doi.org/10.14740/cr2322"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Atrial Fibrillation Management and Outcomes",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Warfarin After Seven Decades: Persistent Value and the Contemporary Role of Vitamin K Antagonism",
  "title_text": "Warfarin After Seven Decades: Persistent Value and the Contemporary Role of Vitamin K Antagonism",
  "type": "peer-reviewed",
  "updated_at": "2026-11-03T12:20:40Z",
  "url": "https://research.draconitic.com/paper/8q3rrrtgmrk4b",
  "venue": "Cardiology research",
  "versions": []
}