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Warfarin

  •  
    Oral
    Warfarin
    Coumadin, Marevan 
    • 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

Potential Indications
BETA

Atrial Fibrillation
Deep Venous Thrombosis
Pulmonary Embolus
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