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Measure content performance. Develop and improve products. List of Partners vendors. If you've been treated for deep venous thrombosis , you can expect at least three months of continued anticoagulants, or blood-thinning medications, such as warfarin, after you leave the hospital. Deep venous thrombosis or deep vein thrombosis is a dangerous condition in which your body forms a clot, typically in the leg, that can potentially break off and travel to the lungs, where it will clog circulation.
This deadly event is known as pulmonary embolism. With continued anticoagulant therapy after you leave the hospital, you minimize the risk of re-forming such deadly blood clots. Note that anticoagulant therapy is not only given with deep venous thrombosis. For example, if you are currently being treated for stroke or have a condition that increases your risk for clots a hypercoagulable condition , you can expect a lifetime of anticoagulation therapy.
Anticoagulation can be maintained by several medications, including low-molecular-weight heparin subcutaneous injection , fondaparinux subcutaneous injection , or oral Xa inhibitors like dabigatran. In this article, we'll focus on warfarin brand name Coumadin , which is commonly available as an oral medication.
Warfarin is used to treat people who have had a previous blood clot, such as:. It's also used to prevent blood clots if you're at high risk of having them in the future. Warfarin is only available on prescription. It comes as tablets and as a liquid that you swallow. When taking warfarin, you need to have regular blood tests. It's important to keep having these tests at the times you're advised during coronavirus. It's also important to tell your doctor straight away if you take warfarin and have tested positive for coronavirus or have coronavirus symptoms.
Take our survey. The usual warfarin dose is 10mg a day for the first 2 days, then between 3mg and 9mg a day after that. Warfarin tablets come in 4 different strengths. The tablets and the boxes they come in are different colours to make it easier for you to take the right dose. Warfarin also comes as a liquid, where 1ml is equal to a 1mg brown tablet. Warfarin liquid comes with a plastic syringe to help you measure the right amount. It's very important to take warfarin as your doctor advises.
Take it once a day at about the same time. It's usual to take warfarin in the evening. This is so that if you need to change the dose after a routine blood test, you can do this the same day rather than waiting until the following morning. Warfarin does not usually upset your stomach, so you can take it whether you have eaten recently or not. If you have had a blood clot in your leg or lungs, you'll probably take a short course of warfarin for 6 weeks to 6 months. If you take warfarin to reduce your risk of having a blood clot in future or because you keep getting blood clots, it's likely your treatment will be for longer than 6 months, maybe even for the rest of your life.
Your warfarin dose may change often, especially in the first few weeks of treatment, until your doctor finds the dose that's right for you. The aim of treatment with warfarin is to thin your blood but not stop it clotting completely. Getting this balance right means your dose of warfarin must be carefully monitored.
You'll have a regular blood test called the international normalised ratio INR. It measures how long it takes your blood to clot. The longer your blood takes to clot, the higher the INR. Most people taking anticoagulants have a ratio of between 2 and 3.
This means their blood takes 2 to 3. The dose of warfarin you need depends on your blood test result. If the blood test result has gone up or down, your warfarin dose will be increased or decreased. You'll have the blood tests at your GP surgery or local hospital's anticoagulant clinic. If your blood test results are stable, you might only need a blood test once every 8 to 12 weeks. If it's unstable or you have just started on warfarin, you might need to have a blood test every week.
When you start taking warfarin, you may be given a yellow book about anticoagulants. This explains your treatment. There's also a section for you to write down and keep a record of your warfarin dose. It's a good idea to take your yellow book with you to all your warfarin appointments. You'll also be given an anticoagulant alert card. Carry this with you all the time. It tells healthcare professionals that you're taking an anticoagulant.
This can be useful for them to know in case of a medical emergency. If you need any medical or dental treatment, show your anticoagulant alert card to the nurse, doctor or dentist beforehand. This includes before you have vaccinations and routine sessions with the dental hygienist.
Your doctor may advise you to stop taking warfarin or reduce your dose for a short time before your treatment. If you have lost your alert card or were not given one, ask your doctor or anticoagulant clinic. It's not a problem if you occasionally forget to take a dose at the correct time.
But if you forget often, your blood could be affected — it might become thicker and put you at risk of having a blood clot. If you do not remember until the next day, skip the missed dose and take your normal dose at the usual time.
You could also ask your pharmacist for advice on other ways to help you remember to take your medicine. If you take an extra dose of warfarin, call your anticoagulant clinic straight away.
If you take more than 1 extra dose of warfarin, you're at risk of serious bleeding. If you need to go to hospital, take the warfarin packet or leaflet inside it, plus any remaining medicine, with you. If you have a yellow book, take that too. While warfarin has enormous benefits, the downside is that it can make you bleed more than normal.
This is because while you're taking warfarin, your blood will not clot as easily. You're more likely to get bleeding problems in the first few weeks of starting warfarin treatment and when you're unwell - for instance, if you have flu, are being sick vomiting or have diarrhoea.
Apart from the risk of bleeding, warfarin is a very safe medicine. The following conditions, alone or in combination, may be responsible for increased INR responses to warfarin: collagen vascular disease, diarrhea or steatorrhea, and neoplastic disease.
Peripheral edema, hereditary coumarin resistance, hyperlipidemia, hypothyroidism and nephrotic syndrome, alone or in combination, have been associated with decreased responses to warfarin. Tobacco smoke contains hydrocarbons that induce hepatic CYP microsomal enzymes.
Because the effect on hepatic microsomal enzymes is not related to the nicotine component of tobacco, sudden tobacco smoking cessation may reduce the clearance and increase the therapeutic effects of warfarin despite the initiation of a nicotine replacement product. However, the decreased warfarin clearance may not always result in a clinically significant change in the PT or INR. Monitor to assess the need for warfarin dosage adjustment when changes in smoking status occur. Geriatric patients are more susceptible to the effects of anticoagulants, possibly due to a decrease in the clearance of warfarin with age.
Limited data suggest no difference in S-warfarin clearance and slightly decreased clearance of R-warfarin with increasing age. Therefore, lower doses of warfarin are usually required to produce a therapeutic level of anticoagulation. In addition, in a retrospective cohort of Medicare beneficiaries mean age However, when analyzed separately by gender, the increased risk of fracture was significant in men odds ratio 1. Furthermore, the risk of fracture was not increased in patients taking warfarin for less than 1 year.
Other independent predictors of fracture in this cohort of patients regardless of the length of warfarin therapy were increasing age, high risk of falls, hyperthyroidism, neuropsychiatric disease, and alcoholism. Factors that were associated with a protective risk of fracture include the Black population, male gender, and the use of beta-adrenergic antagonists.
Because the available alternative therapies e. In addition, unnecessary drugs should be discontinued. Warfarin is contraindicated during pregnancy and in women who may become pregnant except in pregnant women with mechanical heart valves, who are at high risk of thromboembolism, and for whom the benefits of warfarin therapy may outweigh the risks. If warfarin is used during pregnancy or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential hazard to a fetus.
Warfarin crosses the placenta, and fetal plasma concentrations are similar to maternal values. Warfarin embryopathy is especially prominent when taken during the first trimester after the 6th week of gestation, and may cause fetal hemorrhage and an increased risk of spontaneous abortion and fetal mortality.
Warfarin embryopathy is characterized by nasal hypoplasia with or without stippled epiphyses chondrodysplasia punctata and growth retardation including low birth weight. Central nervous system CNS and eye abnormalities have also been reported, including dorsal midline dysplasia characterized by agenesis of the corpus callosum, Dandy-Walker malformation, midline cerebellar atrophy, and ventral midline dysplasia characterized by optic atrophy. Mental retardation, blindness, schizencephaly, microcephaly, hydrocephalus, and other adverse pregnancy outcomes have been reported following warfarin exposure during the second and third trimesters of pregnancy.
In pregnant women with mechanical heart valves, adjusted-dose heparin or adjusted-dose LWWH e. In women at very high risk for thromboembolism e. Warfarin should not be used during labor or immediately after obstetric delivery because of the possibility of hemorrhage.
The safety and efficacy of warfarin have not been established in neonates, infants, children, or adolescents in randomized, controlled clinical trials. However, the use of warfarin in pediatric patients is well-documented for the prevention and treatment of thromboembolic events.
Warfarin was not present in human milk from mothers treated with warfarin from a limited published study. Human data are available; based on published data in 15 breast-feeding mothers, warfarin was not detected in human milk. Among the 15 full-term newborns, 6 nursing infants had documented prothrombin times within the expected range. Prothrombin times were not obtained for the other 9 nursing infants. Effects in premature infants have not been evaluated.
Because of the potential for serious adverse reactions, including bleeding in a breast-fed infant, consider the developmental and health benefits of breast-feeding along with the mother's clinical need for warfarin and any potential adverse effects on the breast-fed infant from warfarin or the underlying maternal condition. Previous American Academy of Pediatrics considered warfarin as usually compatible with breast-feeding. Monitor breast-feeding infants for bleeding or bruising.
Counsel patients about reproductive risk and contraception requirements during warfarin treatment. Warfarin can be teratogenic if taken by the mother during pregnancy. Females of reproductive potential are advised to use effective contraception during treatment and for at least 1 month after the final dose of warfarin.
Verify the pregnancy status of females of reproductive potential with pregnancy testing prior to initiating warfarin therapy. Patients who are planning pregnancy and are receiving warfarin should be counseled regarding the risks of warfarin therapy before pregnancy occurs. If pregnancy is still desired, patients should be advised to either replace warfarin with LMWH e.
PDR Search. Required field. Your Name Your name is required. Recipient's Email Separate multiple email address with a comma Please enter valid email address Recipient's email is required. Thank you. Your email has been sent. Jump to Section. Related Drug Information Drug Summary. NOTE: Clinical practice guidelines recommend against the routine use of pharmacogenetic testing for guiding dosing in patients initiating warfarin therapy. Adults without known risks for enhanced INR response to warfarin.
Geriatric, malnourished or debilitated patients, patients with cardiac failure, hepatic insufficiency, or a higher bleeding risk. Adults who have undergone heart valve replacement.
Neonates, Infants, Children, and Adolescents. For treatment of deep venous thrombosis DVT or pulmonary embolism and deep vein thrombosis DVT prophylaxis or pulmonary embolism prophylaxis. For the treatment and further prevention of DVT or pulmonary embolism PE after the initial, acute phase of treatment. For thrombosis prophylaxis i. NOTE: For information regarding prophylaxis in orthopedic surgery or with central venous catheters, see 'deep venous thrombosis DVT prophylaxis'.
As both underdosing and overdosing can increase risks to patients, several studies have attempted to develop dosing protocols. However, few have investigated how patient weight and body mass index BMI affect warfarin dosing.
Methods: In this retrospective study, we identified patients taking warfarin who had an international normalized ratio INR within the therapeutic range to assess if there was a significant correlation between TWD, that is, maintenance warfarin dosing, and BMI in obese and nonobese patients.
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