Warfarin

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Warfarin


  • take 48-72 hours to take effect
  • Needs continual monitoring of INR
  • Counteracted by Vitamin K injections

Mechanism of action

  • Antagonise Vit K,
  • prevents gamma carboxylation of
    • VIII
    • IX
    • X
    • prothrombin (II)

Route of administration

  • oral
  • Onset of action is 2-3 days
  • duration of action is 5 days  

Indications

  • Treatment of deep vein thrombosis/ pulmonary embolism
  • Atrial fibrillation
    • mitral stenosis
    • thyrotoxicosis,
    • chronic sino-atrial disease
    • congestive cardiomyopathy
    • ischaemic heart disease (it reduces the morbidity from embolism especially stroke)
  • Moderate to severe mitral stenosis in sinus rhythm
  • prosthetic valve replacements

Unwanted effects

  • Haemorrhage
  • unexplained drop in haemocrit
  • hypersensitivity reactions
    • rash
  • hepatic dysfunction
    • jaundice
  • alopecia
  • GI disturbance
    • diarrhoea
    • nausea
    • vomiting
  • purple toes
  • skin necrosis
  • pancreatitis

Contraindications

  • Pregnancy
  • Peptic ulcer
  • Severe hypertension
  • Bacterial endocarditis

Reversed by

  • Vitamin K (phytomenadione)
 

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