We have previously shown that the prevalence of conditions for which warfarin is indicated among nursing home residents is high, use of warfarin among this population is common, and the quality of management of this therapy is suboptimal. As many as 12% of nursing home residents receive warfarin for various reasons (nearly 200,000 nursing home residents nationwide). While oral direct thrombin inhibitors have held some promise as less complicated anticoagulants, ximelagatran has been associated with hepatotoxicity and has not yet received approval by the Food and Drug Administration for use in the U.S. For the foreseeable future, warfarin remains the sole oral anticoagulant available for long-term use in the elderly.