This study aimed to assess the clinical management of warfarin therapy in Western China by investigating: the rate of international normalized ratio (INR) target achievement and its influencing factors, and the incidence and risk factors for hemorrhagic complications. The primary goal was to identify high-risk patient populations requiring intensified monitoring in this resource-limited region with distinct demographic challenges including multi-ethnic populations and limited healthcare access. We conducted a retrospective cohort analysis of 154 consecutive inpatients prescribed warfarin at a tertiary care center in Western China. Data were systematically collected from: baseline demographics, detailed medication histories, INR monitoring results, and documentation of bleeding events. Statistical analysis employed Pearson chi-square tests to evaluate associations between clinical variables and primary outcomes: achievement of target INR ranges (2.0-3.0 for most indications; 1.8-2.5 for mechanical valves) and development of hemorrhagic complications. Secondary analysis examined factors influencing bleeding severity. The study revealed several critical findings regarding INR control: the overall therapeutic achievement rate was 32.3% for the 2.0-3.0 range (n = 130) and 50.0% for the 1.8-2.5 range (n = 24). Notably, we observed universal therapeutic failure (0% achievement) in three high-risk subgroups: octogenarians (≥ 81 years), underweight patients (BMI < 18.5 kg/m), and amiodarone users. In contrast, structured physician education demonstrated substantial benefit (72.13% achievement rate vs 27.87% without instruction). Regarding safety outcomes, Bleeding complications were strongly associated with heart failure (16.07% vs 83.93% without), pulmonary infections (20.72% vs 79.28% without), and PPI use (42.86% vs 57.14%). A striking disparity emerged in bleeding severity: cardiothoracic surgery patients experienced minor bleeding at markedly higher rates (66.7%) compared to other departments (≤ 6.7%). This study identifies three high-risk populations in Western China requiring prioritized monitoring: vulnerable patients (advanced age, low BMI), individuals with cardiopulmonary comorbidities, and those prescribed interacting medications (amiodarone, PPIs). These findings have important clinical implications, particularly for resource-limited settings, we propose: implementation of Structured Medication Education Programs, intensive medication monitoring for high-risk patients, development of specialty-specific monitoring protocols in cardiothoracic departments, and establishment of multidisciplinary anticoagulation management teams. These findings underscore the need for context-specific strategies to optimize warfarin therapy in ethnically diverse, under-resourced regions, while highlighting critical areas for future research.