In the era of direct oral anticoagulants, vitamin K antagonists retain a clinically relevant role in thrombotic disorders. In Italy, approximately 20% of the patients on anticoagulant therapies receives a VKA, in most cases warfarin. The optimal management of this drug is challenging and cannot disregard its intricate and unpredictable pharmacokinetic properties and patient's thrombotic and bleeding risk. Several clinical issues encountered during warfarin treatment are still unanswered and are tentatively addressed by physicians. In this regard, the Italian Federation of Centers for the diagnosis of thrombotic disorders and the Surveillance of the Antithrombotic therapies (FCSA) provides some experience-based good clinical practice's suggestions on the following topics: (1) how to start the anticoagulant treatment with warfarin and warfarin induction regimen; (2) how to manage a subtherapeutic INR value; (3) how to manage a supratherapeutic INR value in asymptomatic patients; and (4) how to manage the association of warfarin with interfering drugs.

在直接口服抗凝药时代，维生素 K 拮抗剂在血栓性疾病中保留了临床相关作用。在意大利，大约 20% 接受抗凝治疗的患者接受 VKA，大多数情况下是华法林。该药物的最佳管理具有挑战性，不能忽视其复杂且不可预测的药代动力学特性以及患者的血栓和出血风险。华法林治疗期间遇到的几个临床问题仍未得到解答，并正在由医生尝试解决。对此，意大利血栓性疾病诊断和抗血栓治疗监测中心联合会（FCSA）针对以下主题提供了一些基于经验的良好临床实践建议：（1）如何开始华法林抗凝治疗和华法林诱导方案； (2) 如何管理亚治疗INR值； (3) 如何管理无症状患者的超治疗INR值； (4) 如何管理华法林与干扰药物的关联。