• Mechanism of Action
• Inhibits regeneration of vitamin K from vitamin K epoxide, resulting in reduced synthesis of clotting factors II, VII, IX and X, as well as proteins C and S.
• • Pharmacology
  • Delayed onset and initial procoagulant effect - bridging heparin / clexane should be used until warfarin is therapeutic.
  • Reversed with vitamin K, fresh frozen plasma and prothrombinex.

Clinical Use

• • Indications
  • Treatment of venous thromboembolism (DVT / PE)
  • Prosthetic heart valve (prevention of thromboembolism)
  • Atrial fibrillation (prevention of stroke) - particularly valvular AF
  • Large myocardial infarction
• • Contraindications
  • Active bleeding, or high risk of bleeding (risk / benefit analysis)
  • Cancer-associated venous thromboembolism (enoxaparin / factor Xa inhibitors are superior)
  • Pregnancy
• • Adverse Effects
  • Haemorrhage
  • Skin necrosis
  • Cholesterol microemboli
• • Monitoring
  • International normalised ratio (INR).
  • AF / VTE - generally aim INR 2.0 - 3.0
  • Prosthetic heart valve - generally aim INR 2.5 - 3.5