Hematology and Oncology Book

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WarfarinAka: Coumadin

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  1. See Also
    1. Coumadin Drug Interactions
    2. Coumadin Protocol
    3. Coumadin Protocol for the Perioperative Period
    4. Heparin
  2. Mechanism
    1. Inhibits Vitamin K participation in factor synthesis
    2. Vitamin K dependent coagulation proteins
      1. Procoagulant Activity
        1. Factor II (72 hour half life)
        2. Factor VII (8 hour half life)
        3. Factor IX (24 hour half life)
        4. Factor X (39 hour half life)
      2. Anticoagulant Activity
        1. Protein C (14 hour half life)
        2. Protein S (42 hour half life)
    3. Coumadin has an initial paradoxical procoagulant effect
      1. Anticoagulant factors are depleted first
      2. Concurrently administer Heparin for first 4-5 days
  3. Monitoring: Target INR
    1. INR between 2.0 and 3.0
      1. Most conditions
      2. Hip replacement or ORIF Fracture (for 28-35 days)
      3. Elective total knee arthroplasty (for 10 days)
      4. Atrial Fibrillation
        1. High CVA risk
        2. Persistent, paroxysmal Atrial Fibrillation, flutter
        3. Cardioversion (3 weeks before, 4 weeks after)
      5. Deep Vein Thrombosis
        1. First episode with reversible risks: 3 months
        2. First episode and idiopathic: 6-12 months
        3. Cancer: LMWH x3-6 months, then warfarin longterm
        4. Antiphospholipid Antibody: 12 months or longterm
        5. Two Thrombophilias: 12 months or longterm
        6. Clotting disorder related: 6-12 months or longterm
        7. Two or more episodes: Longterm
    2. INR between 2.5 and 3.5
      1. Mechanical heart valves
        1. Ball and cage valve
        2. Comorbid Atrial Fibrillation, CHF, MI, LAE
        3. Mitral valve replacement
      2. Antiphospholipid Syndrome (Lupus Anticoagulant)
      3. Prevent recurrent Myocardial Infarction
        1. Indicated in Aspirin intolerant patient
  4. Dosing Protocol
    1. See Coumadin Protocol

Warfarin (C0043031)

Definition (MSH)An anticoagulant that acts by inhibiting the synthesis of vitamin K-dependent coagulation factors. Warfarin is indicated for the prophylaxis and/or treatment of venous thrombosis and its extension, pulmonary embolism, and atrial fibrillation with embolization. It is also used as an adjunct in the prophylaxis of systemic embolism after myocardial infarction. Warfarin is also used as a rodenticide.
Definition (CSP)synthetic coumarin anticoagulant.
Definition (NCI)A drug that prevents blood from clotting. It belongs to the family of drugs called anticoagulants (blood thinners).
Definition (PDQ)A synthetic anticoagulant. Warfarin appears to inhibit the regeneration of vitamin K1 epoxide and so the synthesis of vitamin K dependent clotting factors, which include Factors II, VII, IX and X, and the anticoagulant proteins C and S. This inhibition results in a sequential depression of Factors VII, IX, X and II activities. Vitamin K is an essential cofactor for the post ribosomal synthesis of the vitamin K dependent clotting factors. The vitamin promotes the biosynthesis of gamma-carboxyglutamic acid residues in these proteins which are essential for biological activity. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39740&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=39740&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C945" NCI Thesaurus)
Definition (NCI)A synthetic anticoagulant. Warfarin appears to inhibit the regeneration of vitamin K1 epoxide and so the synthesis of vitamin K dependent clotting factors, which include Factors II, VII, IX and X, and the anticoagulant proteins C and S. This inhibition results in a sequential depression of Factors VII, IX, X and II activities. Vitamin K is an essential cofactor for the post ribosomal synthesis of the vitamin K dependent clotting factors. The vitamin promotes the biosynthesis of gamma-carboxyglutamic acid residues in these proteins which are essential for biological activity. (NCI04)
ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121) , Hazardous or Poisonous Substance (T131)
MSHD014859
English3-Alpha-phenyl-beta-acetylethyl-4-hydroxycoumarin, WARF, Warfarin, WARFARIN PREPARATION
Spanishwarfarina
Parent Concepts4-hydroxycoumarin (C0097101), Anticoagulants (C0003280), coumarin (C0010206), 4-Hydroxycoumarins (C0000506), Rodenticides (C0035805), Coumarin anticoagulant (C0360596), Anticoagulants, Oral (C0354604)
SourcesAOD, CSP, LNC, MSH, MTH, NCI, NDFRT, PDQ, RXNORM, SCTSPA, SNOMEDCT, USPMG, VANDF
Derived from the NIH UMLS (Unified Medical Language System)


Coumadin (C0699129)

ConceptsOrganic Chemical (T109) , Pharmacologic Substance (T121)
MSHD014859
EnglishBoots Brand of Warfarin Sodium, Bristol-Myers Squibb Brand of Warfarin Sodium, Coumadin, Goldshield Brand of Warfarin Sodium, Marevan
SourcesCSP, MSH, NCI, PDQ, RXNORM
Derived from the NIH UMLS (Unified Medical Language System)



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