Warfarin
Posted by dkwinter

Impairs Vitamin K-dependent carboxylation of factors II, VII, IX, X, C, S and Z.
See also: 
     Anticoagulation

     Anticoagulation in atrial fibrillation
     DVT
Uses
     Reduces risk of embolic stroke in atrial fibrillation. Goal INR 2-3 in patients with CHADS2 >=2.
     DVT
     Secondary prevention of MI in patients with known CAD
Administration
     Typically preceded by heparin for 3 or 4 days to allow the warfarin to become therapeutic and prevent initial hypercoagulability due to decrease in protein C
Dosing
     1 tab, 2-10 mg PO daily, start low and go slow, follow INR
Metabolism
     Liver. CYP450.
     Urine T1/2 20-60 hrs, highly variable
Adverse-effects
     Teratogenic. Pregnancy class X. Period of sensitivity is 4-6 weeks.
          Fetal Warfarin syndrome includes many deformities including heart defects.
     Can see short-term hypercoagulability due to decrease of Protein C, which is anticoagulating -> develop thrombotic occlusion of microvasculature -> "warfarin-induced skin necrosis"