Dr Horn is indeed correct that most of the alerts in our study were triggered by warfarin being prescribed to patients who already were receiving trimethoprim-sulfamethoxazole. Some of this was due to warfarin being prescribed 3 times more commonly than trimethoprim-sulfamethoxazole, as noted in our article.1 Dr Horn points out that dose titration of the warfarin might have allowed it to be used safely in patients already receiving trimethoprim-sulfamethoxazole. However, such patients might then be at risk of underanticoagulation when stopping therapy with trimethoprim-sulfamethoxazole, in most cases after being discharged from the hospital.
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