Which of the following actions should be AVOIDED to successfully convert a patient from heparin to the oral anticoagulant warfarin? A - Discontinuing heparin without ensuring adequate anticoagulation with warfarin B - Starting warfarin at a low dose without monitoring the INR C - Failing to adjust the warfarin dose based on INR results D - Initiating warfarin therapy before the patient has been stabilized on heparin