<![CDATA[Atrial fibrillation (AF) is a common arrhythmia requiring long-term anticoagulant therapy, such as warfarin, to prevent thromboembolic events. However, warfarin's narrow therapeutic index and high susceptibility to drug interactions pose significant challenges to maintaining International Normalized Ratio (INR) stability. This narrative review evaluates the impact of warfarin drug interactions on clinical outcomes in AF patients by analyzing ten studies published between 2020 and 2025. Literature searches were conducted via PubMed using a five-year publication filter. The findings indicate that interactions with antibiotics (sulfonamides, quinolones), antifungals (fluconazole), and CYP2C9-modulating agents (NSAIDs, anticonvulsants) significantly increase the risk of over-anticoagulation, leading to INR spikes above 10 and a higher incidence of major bleeding. Furthermore, concurrent use of immune checkpoint inhibitors (ICIs) in cancer patients was associated with increased hepatotoxicity risks. This review concludes that intensive INR monitoring, interaction-based dosage adjustments, and the consideration of Non-vitamin K Oral Anticoagulants (NOACs) as alternatives are essential strategies to enhance therapeutic safety. Proactive management of drug interactions is crucial to minimizing fatal complications in AF patients receiving warfarin.]]>
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