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Warfarin

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by

Sa Sha

on 24 October 2013

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Transcript of Warfarin

Warfarin
Would you like brussels sprouts with that?
Sahar Shariflou
Thrombosis
1 death every 5 minutes
10-30% die within a month of diagnosis
Gamma - carboxyglutamic acid
Glutamic acid
Oxygen
Carbon dioxide
Reduced Vitamin K
Oxidised Vitamin K
Vitamin K
Vitamin K reductase
II
VII
IX
X
Coagulation factors:
Protein C
Protein Z
Protein S
Warfarin
Vitamin K reductase
Anticoagulant effect may be affected by:
Genetic factors
Drug interactions
Co-morbidities
Dietary factors
Resulting in:
Increased risk of thromboembolism
Increased risk of significant bleeding
Therefore...
Narrow therapeutic index
Frequent monitoring of International Normalised Ratio (INR)
Absorption
Hepatic metabolism
Pharmacokinetic
Pharmacodynamic
Cancer
Congestive heart failure
Vitamin K
Vitamin C
Vitamin E
Garlic
Ginger
Alcohol
Vascular injury
Tissue factor
VIIa
VII
Thrombin
Prothrombin
Xa
X
Va
VIIIa
Va
Va
Apixiban
Dabigatran
Rivaroxaban
Warfarin
Dabigatran
36-72 hours
2 hours
Frequent
No
All vitamin K dependant clotting factors
Thrombin
Inhibits
Onset
Dose adjustments
Coagulation measurement
Yes
No
GI symptoms
No
Yes
Use in renal impairment
Unsafe
Safe
Antidote
Yes
No
Food/drug interactions
Minimal
Plenty
Long-term safety
Safe
Lack of data
References
[1] Bayer Pharma AG 2013, Thromboembolic diseases: a major global health concern, viewed October 5 2013, <http://www.thrombosisadviser.com/en/understanding-thrombosis/>

[2] Centers for Disease Control and Prevention (CDC) 2012, Deep Vein Thrombosis (DVT) / Pulmonary Embolism (PE) – Blood Clot Forming in a Vein, Data & Statistics, CDC, Atlanta, GA, USA, viewed September 30 2013, <http://www.cdc.gov/ncbddd/dvt/data.html>


[3] Glurich, I., J.K. Burmester, and M.D. Caldwell 2010, ‘Understanding the pharmacogenetic approach to warfarin dosing’, Heart Fail Rev, vol. , no. 3. p. 239-48.

[4] Golembiewski, J.A. 2011, ‘Dabigatran: a new oral anticoagulant’, J Perianesth Nurs, vol. 26, no.6. p. 420-3.

[5] Hori, M., et al. 2013, ‘Dabigatran versus warfarin: effects on ischemic and hemorrhagic strokes and bleeding in Asians and non-Asians with atrial fibrillation’, Stroke, vol. 44, no.7. p. 1891-6.
[6] Nature Video 2011, The 50-year quest to replace warfarin, viewed 1 October 2013.

[7] Peetz, D. and K.J. Lackner 2010, ‘Dabigatran versus warfarin for venous thromboembolism’, N Engl J Med, vol. 362, no.11. p. 1050; author reply 1050-1.

[8] Pettit, S.J., A.G. Japp, and R.S. Gardner 2012, ‘The hazards of brussels sprouts consumption at Christmas’, Med J Aust, vol. 197, no.11. p. 661-2.

[9] Science Daily 2011, Every Five Minutes Someone Dies from a Blood Clot or Deep Vein Thrombosis, viewed October 5 2013, <http://www.sciencedaily.com/releases/2011/03/110305105233.htm>

[10] Tadros, R. and S. Shakib 2010, ‘Warfarin--indications, risks and drug interactions’, Aust Fam Physician, vol 39, no.7. p. 476-9.

[11] WA Medication Safety Group (WAMSG) 2007, Living with warfarin, Department of health.

References
[1] Bayer Pharma AG 2013, Thromboembolic diseases: a major global health concern, viewed October 5 2013, <http://www.thrombosisadviser.com/en/understanding-thrombosis/>

[2] Centers for Disease Control and Prevention (CDC) 2012, Deep Vein Thrombosis (DVT) / Pulmonary Embolism (PE) – Blood Clot Forming in a Vein, Data & Statistics, CDC, Atlanta, GA, USA, viewed September 30 2013, <http://www.cdc.gov/ncbddd/dvt/data.html>


[3] Glurich, I., J.K. Burmester, and M.D. Caldwell 2010, ‘Understanding the pharmacogenetic approach to warfarin dosing’, Heart Fail Rev, vol. , no. 3. p. 239-48.

[4] Golembiewski, J.A. 2011, ‘Dabigatran: a new oral anticoagulant’, J Perianesth Nurs, vol. 26, no.6. p. 420-3.

[5] Hori, M., et al. 2013, ‘Dabigatran versus warfarin: effects on ischemic and hemorrhagic strokes and bleeding in Asians and non-Asians with atrial fibrillation’, Stroke, vol. 44, no.7. p. 1891-6.
[6] Nature Video 2011, The 50-year quest to replace warfarin, viewed 1 October 2013.

[7] Peetz, D. and K.J. Lackner 2010, ‘Dabigatran versus warfarin for venous thromboembolism’, N Engl J Med, vol. 362, no.11. p. 1050; author reply 1050-1.

[8] Pettit, S.J., A.G. Japp, and R.S. Gardner 2012, ‘The hazards of brussels sprouts consumption at Christmas’, Med J Aust, vol. 197, no.11. p. 661-2.

[9] Science Daily 2011, Every Five Minutes Someone Dies from a Blood Clot or Deep Vein Thrombosis, viewed October 5 2013, <http://www.sciencedaily.com/releases/2011/03/110305105233.htm>

[10] Tadros, R. and S. Shakib 2010, ‘Warfarin--indications, risks and drug interactions’, Aust Fam Physician, vol 39, no.7. p. 476-9.

[11] WA Medication Safety Group (WAMSG) 2007, Living with warfarin, Department of health.

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Full transcript