Days 15 to

1. Measure PT/INR every 1 to 4 weeks based on the stability of the INR and patient's health status.

2. Interview the patient to determine if there is worsening or new symptoms related to VTE. Inquire about and evaluate patient adherence to therapy. Ask the patient about overt bruising or bleeding as well as changes in stool or urine color. Encourage the patient to increase activity as tolerated. Reinforce previous patient education regarding vitamin K intake and potential drug-drug interactions with warfarin.

3. Adjust warfarin dose as necessary. Consider restarting LMWH or fondaparinux if INR drops below 1.5.

4. Document activities in medical record.

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