{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T10:51:39Z","timestamp":1783075899597,"version":"3.54.6"},"reference-count":9,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2018,2,19]],"date-time":"2018-02-19T00:00:00Z","timestamp":1518998400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Pharmacy Practice"],"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:p>The warfarin management strategy for a mechanical mitral valve patient initiated on a ritonavir-based hepatitis C treatment regimen is described. A 62-year-old male with a past medical history of hepatitis C genotype 1a and stable warfarin dose history was initiated on a concomitant Viekira Pak\u00ae (VP) regimen containing ritonavir. Prior to initiation of the VP for hepatitis C treatment, the patient was stable on a warfarin dose of 40 mg\/wk for 5 months. During treatment with VP, the patient experienced a markedly decreased international normalized ratio (INR) and warfarin requirements ultimately increased 125% from baseline (90 mg\/wk). Effective anticoagulation management throughout and surrounding the treatment period for hepatitis C involved frequent warfarin dose adjustments, including preemptive changes, close monitoring, and repeated use of enoxaparin to ensure adequate thrombotic prophylaxis. This is believed to be the first reported case describing the management of warfarin in a patient with hepatitis C who received VP and required a drastically increased weekly warfarin dose. The possible mechanisms suggestive of this interaction and similar case reports in the literature are discussed.<\/jats:p>","DOI":"10.1177\/0897190018758541","type":"journal-article","created":{"date-parts":[[2018,2,19]],"date-time":"2018-02-19T20:31:38Z","timestamp":1519072298000},"page":"470-473","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Inductive Effect of a Ritonavir-Containing Hepatitis C Treatment Regimen on Warfarin in a Patient\u2014A Case Report"],"prefix":"10.1177","volume":"32","author":[{"given":"Audrey C.","family":"Rosene","sequence":"first","affiliation":[{"name":"Le Bonheur Children\u2019s Hospital, Memphis, TN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaymee L.","family":"Gaspar","sequence":"additional","affiliation":[{"name":"VA Northern Indiana Healthcare System, Marion, IN, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2018,2,19]]},"reference":[{"key":"bibr1-0897190018758541","doi-asserted-by":"publisher","DOI":"10.1378\/chest.11-2305"},{"key":"bibr2-0897190018758541","unstructured":"Belperio PS, Morgan TR, Burton MJ, et al. Chronic Hepatitis C Virus Infection: Treatment Considerations from the Department of Veterans Affairs National Hepatitis C Resource Center Program and the Office of Public Health. Updated July 2015. Accessed October 19, 2015."},{"issue":"4","key":"bibr3-0897190018758541","first-page":"15","volume":"9","author":"Boffito M","year":"2004","journal-title":"The PRN Notebook"},{"key":"bibr4-0897190018758541","volume-title":"Lexi-Comp Online [online database]","author":"Ritonavir [monograph]"},{"key":"bibr5-0897190018758541","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.061284"},{"key":"bibr6-0897190018758541","unstructured":"Coumadin\u00ae (warfarin sodium) [package insert]. Princeton, NJ: Bristol-Myers Squibb; 2015."},{"key":"bibr7-0897190018758541","first-page":"13","volume":"2011","author":"Horn JR","journal-title":"Pharmacy Times"},{"key":"bibr8-0897190018758541","doi-asserted-by":"publisher","DOI":"10.1086\/524086"},{"key":"bibr9-0897190018758541","doi-asserted-by":"publisher","DOI":"10.1111\/jcpt.12475"}],"container-title":["Journal of Pharmacy Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0897190018758541","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0897190018758541","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0897190018758541","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T00:34:52Z","timestamp":1777509292000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0897190018758541"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,2,19]]},"references-count":9,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2019,8]]}},"alternative-id":["10.1177\/0897190018758541"],"URL":"https:\/\/doi.org\/10.1177\/0897190018758541","relation":{},"ISSN":["0897-1900","1531-1937"],"issn-type":[{"value":"0897-1900","type":"print"},{"value":"1531-1937","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,2,19]]}}}