Indications :
Contraindications:
Dosing :
- Should be bridged with a parenteral anticoagulant (UFH/LMWH) for at least 5 days and until the INR is 2 or greater for at least 24 hours.
- When to bridge:
- Bridging therapy when warfarin is temporarily stopped for an invasive procedure is not necessary for most patients and is associated with increased bleeding complications without additional anticoagulant benefit.
- Exceptions:
- patients with VTE within the past 4 weeks
- history of VTE during anticoagulant interruption for surgery
- procedure with very high VTE risk, such as orthopedic surgery
- patients with atrial fibrillation who have had a stroke or transient ischemic attack in the preceding year
- patients who have multiple risk factors for stroke (CHADS2 score of 5-6)
- most patients with a mechanical heart valve.
MoA :
Pharmacokinetics :
Toxicities/Monitoring :
- Overdose:
- Patients with asymptomatic INR elevation between 4.5 and 10 can often be managed by simply withholding warfarin.
- For INRs greater than 10 in patients without bleeding, oral vitamin K should be given.
- In patients experiencing life-threatening bleeding, give vitamin K + 4-factor PCC