A 1,021-patient propensity-matched cohort found that starting a GLP-1 receptor agonist dropped time in therapeutic range by 2.1 percentage points (p=0.01) and increased time above range by 1.3 points. Mean INR did not shift — variance did. The interaction is behavioral, not pharmacokinetic: appetite suppression makes vitamin K intake variable, and warfarin's narrow window tracks that variability.