Warfarin is an anticoagulant used as a medication under several brand names including Coumadin.[9] While the drug is described as a "blood thinner", it does not reduce viscosity but rather inhibits coagulation. Accordingly, it is commonly used to prevent blood clots in the circulatory system such as deep vein thrombosis and pulmonary embolism, and to protect against stroke in people who have atrial fibrillation, valvular heart disease, or artificial heart valves.[9] Less commonly, it is used following ST-segment elevation myocardial infarction (STEMI) and orthopedic surgery.[9] It is usually taken by mouth, but may also be administered intravenously.[9]
The common side effect, a natural consequence of reduced clotting, is bleeding.[9] Less common side effects may include areas of tissue damage, and purple toes syndrome.[9] Use is not recommended during pregnancy.[9] The effects of warfarin are typically monitored by checking prothrombin time (INR) every one to four weeks.[9] Many other medications and dietary factors can interact with warfarin, either increasing or decreasing its effectiveness.[9][10] The effects of warfarin may be reversed with phytomenadione (vitamin K1), fresh frozen plasma, or prothrombin complex concentrate.[10]
Warfarin decreases blood clotting by blocking vitamin K epoxide reductase, an enzyme that reactivates vitamin K1.[10] Without sufficient active vitamin K1, the plasma concentrations of clotting factors II, VII, IX, and X are reduced and thus have decreased clotting ability.[10] The anticlotting protein C and protein S are also inhibited, but to a lesser degree.[10]
Despite being labeled a vitamin K antagonist, warfarin does not antagonize the action of vitamin K1, but rather antagonizes vitamin K1 recycling, depleting active vitamin K1.
A few days are required for full effect to occur, and these effects can last for up to five days.[9][11] Because the mechanism involves enzymes such as VKORC1, patients on warfarin with polymorphisms of the enzymes may require adjustments in therapy if the genetic variant that they have is more readily inhibited by warfarin, thus requiring lower doses.[12][13]
Warfarin first came into large-scale commercial use in 1948 as a rat poison.[14][15] It was formally approved as a medication to treat blood clots in humans by the U.S. Food and Drug Administration in 1954.[9] In 1955, warfarin's reputation as a safe and acceptable treatment was bolstered when President Dwight D. Eisenhower was treated with warfarin following a massive and highly publicized heart attack.[16] Eisenhower's treatment kickstarted a transformation in medicine whereby coronary artery disease, arterial plaques, and ischemic strokes were treated and protected against by using anticoagulants such as warfarin. It is on the World Health Organization's List of Essential Medicines.[17][18] Warfarin is available as a generic medication[19] and under many trade names.[1] In 2021, it was the 56th most commonly prescribed medication in the United States, with more than 11million prescriptions.[20][21]
^ abCite error: The named reference brands was invoked but never defined (see the help page).
^Cite error: The named reference brands2 was invoked but never defined (see the help page).
^Cite error: The named reference brands3 was invoked but never defined (see the help page).
^"Warfarin Use During Pregnancy". Drugs.com. 4 September 2019. Archived from the original on 9 February 2018. Retrieved 7 February 2020.
^"FDA-sourced list of all drugs with black box warnings (Use Download Full Results and View Query links.)". nctr-crs.fda.gov. FDA. Retrieved 22 October 2023.
^"Coumadin- warfarin sodium tablet". DailyMed. Archived from the original on 26 December 2021. Retrieved 25 December 2021.
^Holford NH (December 1986). "Clinical pharmacokinetics and pharmacodynamics of warfarin. Understanding the dose-effect relationship". Clinical Pharmacokinetics. 11 (6): 483–504. doi:10.2165/00003088-198611060-00005. PMID 3542339. S2CID 92210077.
^ abcdCite error: The named reference TGA was invoked but never defined (see the help page).
^ abcdefghijk"Warfarin sodium". The American Society of Health-System Pharmacists. 13 October 2022. Archived from the original on 12 June 2018. Retrieved 16 February 2023.
^ abcdeAgeno W, Gallus AS, Wittkowsky A, Crowther M, Hylek EM, Palareti G (February 2012). "Oral anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines". Chest. 141 (2 Suppl): e44S–e88S. doi:10.1378/chest.11-2292. PMC 3278051. PMID 22315269.
^Arcangelo VP, Peterson AM (2006). Pharmacotherapeutics for Advanced Practice: A Practical Approach. Lippincott Williams & Wilkins. p. 774. ISBN 978-0-7817-5784-3. Archived from the original on 18 September 2017.
^Dasgupta A, Wahed A (2014). "Pharmacogenomics". Clinical Chemistry, Immunology and Laboratory Quality Control. pp. 353–362. doi:10.1016/B978-0-12-407821-5.00020-6. ISBN 978-0-12-407821-5.
^"Warfarin". ScienceDirect. Archived from the original on 16 November 2021. Retrieved 16 November 2021.
^Ravina E (2011). The Evolution of Drug Discovery: From Traditional Medicines to Modern Drugs. John Wiley & Sons. p. 148. ISBN 978-3-527-32669-3. Archived from the original on 18 September 2017.
^Cite error: The named reference poison was invoked but never defined (see the help page).
^Lim GB (December 2017). "Milestone 2: Warfarin: from rat poison to clinical use". Nature Reviews. Cardiology. doi:10.1038/nrcardio.2017.172. PMID 29238065.
^World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl:10665/325771. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
^World Health Organization (2021). World Health Organization model list of essential medicines: 22nd list (2021). Geneva: World Health Organization. hdl:10665/345533. WHO/MHP/HPS/EML/2021.02.
^British national formulary (69 ed.). British Medical Association. 2015. pp. 154–155. ISBN 978-0-85711-156-2.
^"The Top 300 of 2021". ClinCalc. Archived from the original on 15 January 2024. Retrieved 14 January 2024.
^"Warfarin - Drug Usage Statistics". ClinCalc. Archived from the original on 13 April 2020. Retrieved 14 January 2024.
Warfarin is an anticoagulant used as a medication under several brand names including Coumadin. While the drug is described as a "blood thinner", it does...
(4-hydroxycoumarins, such as warfarin). Warfarin necrosis is a rare but severe complication of treatment with warfarin or related anticoagulants. The...
Fetal warfarin syndrome is a disorder of the embryo which occurs in a child whose mother took the medication warfarin (brand name: Coumadin) during pregnancy...
heart–lung machines, and dialysis equipment. One of the first anticoagulants, warfarin, was initially approved as a rodenticide. Anticoagulants are closely related...
warfarin and does not require monitoring by blood tests. In a meta analysis of 7 different studies, there was no benefit of dabigatran over warfarin in...
treatment for factor V deficiency. Reversal of warfarin effect: Patients who are anticoagulated with warfarin are deficient in the functional vitamin K dependent...
Warfarin resistance is a rare condition in which people have varying degrees of tolerance to the anticoagulant drug warfarin. In incomplete warfarin resistance...
the "fraction bound" of the anticoagulant warfarin is 97%. This means that out of the amount of warfarin in the blood, 97% is bound to plasma proteins...
determine the clotting tendency of blood, in such things as the measure of warfarin dosage, liver damage, and vitamin K status. PT measures the following coagulation...
in those with a history of prior clots. It is used as an alternative to warfarin and does not require monitoring by blood tests or dietary restrictions...
administration of ezetimibe to people who take warfarin (a vitamin K antagonist) would potentiate the warfarin effect. This has been confirmed in humans....
most commonly implicated conventional drugs in herb-drug interactions are warfarin, insulin, aspirin, digoxin, and ticlopidine, due to their narrow therapeutic...
is unclear if use in pregnancy and breastfeeding is safe. Compared to warfarin it has fewer interactions with other medications. It works by blocking...
reducing the risk of stroke, heart attack and pulmonary embolism. Heparin and warfarin are used to inhibit the formation and growth of existing thrombi, with...
intake of vitamin K. For this reason, individuals taking the anticoagulant warfarin, which acts by inhibiting vitamin K, are instructed to minimize consumption...
superwarfarins because they are much more potent and long acting than warfarin. Brodifacoum Bromadiolone Difenacoum Flocoumafen Feinstein, D. L; Akpa...
thrombocytopenia. Often these individuals require long-term anticoagulation. If warfarin is chosen as the long-term anticoagulant, this poses particular challenges...
toe syndrome, and allergic rashes. A rare but severe adverse effect is warfarin necrosis of the skin and subcutaneous tissue during the first days of treatment...
PMID 18728265. "Broom". WebMD. Chan, T. Y. (2001). "Interaction between warfarin and danshen (Salvia miltiorrhiza)". The Annals of Pharmacotherapy. 35 (4):...
normalized ratio (INR) is also a warfarin study, with normal ranges of 2–3 for standard warfarin and 3–4.5 for high-dose warfarin. In a veterinary study of bovine...
requirements and as a potential player in vitamin K deficiency disorders. Warfarin is a commonly prescribed oral anticoagulant, or blood thinner used to treat...
angioplasty. Of the anticoagulants, warfarin (and related coumarins) and heparin are the most commonly used. Warfarin affects the vitamin K-dependent clotting...
crystal embolism, atheroembolism, blue toe, purple toe syndrome, trash foot, warfarin blue toe syndrome: 338 Micrograph showing a cholesterol embolus in a medium...
most commonly used VKAs. In medicine, the most commonly used VKA is warfarin. Warfarin was initially used as a rodenticide, but made the transition to pharmaceutical...
if pure factor IX is not available. It may also be used for reversal of warfarin therapy. It is given by slow injection into a vein. Common side effects...
antiplatelet drugs such as aspirin or with anticoagulants such as heparin or warfarin. Vertebral artery dissection is less common than carotid artery dissection...
considered as an alternative to warfarin, particularly if a person is on several other medications that interact with warfarin, or if attending medical appointments...
hyperparathyroidism, and hypervitaminosis D. In rare cases, certain medications such as warfarin can also result in calciphylaxis. The first skin changes in calciphylaxis...