Anticoagulation therapy poses multiple risks to patients and contributes to thousands of health-care dollars in treating complications. These risks have been shown to decrease when patients are monitored in a warfarin clinic. Even in the setting of a warfarin clinic, complications can occur, most of which are related to patient compliance. Warfarin clinics have limited options for addressing issues of compliance. Direct observed therapy is a technique that warfarin clinics can use to highlight issue of noncompliance to more safely manage patients on warfarin. A short course of direct observed therapy is a feasible method to confirm compliance with anticoagulation medication. Direct observed therapy allows providers to adjust medication based on real data and not just patient statements of compliance. Direct observed therapy also allows providers to confront patients with tangible evidence of noncompliance that cannot be refuted.