What is Warfarin?

Warfarin is an anticoagulant drug that is also known under the brand names of Coumadin, Jantoven, Marevan, Lawarin and Waran.

Initially marketed as a pesticide for rodents, it was soon found to have beneficial qualities in the prevention of thrombosis and embolism. It has been approved for medical use for over fifty years and continues to be a commonly used anticoagulant drug throughout the world today.

Pharmacology

Warfarin works to decrease blood coagulation and, therefore, lower risk thrombosis and embolism, by inhibition of the enzyme that is responsible for the oxidation of vitamin K in the liver.

Vitamin K is important for the normal process of coagulation, which is why warfarin affects the process of blood clotting and reduces the risk of thrombosis.

Benefits and Risks

When making the therapeutic decision as to whether warfarin is the justified, it is prudent to consider both the benefits of risks of taking the medication.

The primary benefit of warfarin is the reduced clotting factors and related decreased risk of thrombosis. The value of this benefit varies according to the likelihood of the patient to suffer from this condition and the severity if it does occur. People with a family history of deep venous thrombosis, for example, may benefit more from the use of warfarin, as well as those that have concurrent medical conditions, such as heart disease or a previous stroke.

This benefit must then be weighed up against the risks that warfarin may pose to the patient. The most important consideration is increased risk of bleeding, due to the way the medication works. As a result, patients taking warfarin may notice that they bruise more easily and any cuts usually take longer to stop bleeding. If the individual is likely to suffer from bleeds, such as an elderly person that falls regularly, the risk of taking warfarin is greater.

Side Effects

The side effects of warfarin may include:

• Abdominal pain
• Bloating
• Chills
• Fever
• Gastrointestinal bleeding
• Headache
• Long nosebleeds
• Nausea and vomiting
• Taste changes

Drug Interactions

Warfarin is well known for the vast number of medications with which it interacts, as it exerts its effect in the liver where most drugs are metabolized.

It is wise to double-check the medication history of any patient that may be advised to begin therapy with warfarin, including over the counter products. Some herbal medications, such as St. John’s Wort can also change the concentration of vitamin K in the blood and have a dramatic effect on bleeding and coagulation.

Additionally, some food sources can interact with warfarin, such as grapefruit and cranberry juice. Foods high in vitamin K like spinach can also affect clotting factors and the effect of warfarin.

Patient Advice

When a patient begins taking warfarin therapy, it is important that they receive the appropriate communication about the effects of this drug.

Warfarin should be taken orally once a day at the same time, although it with or without food does not make a difference. It is important that the brand of warfarin chosen to take remains the same as the effect of different brands may vary slightly. If a dose is missed, it should be taken as soon as the patient remembers, although two doses should never be taken together if not realized until the next day.

Frequent blood tests will be required, especially at the commencement of therapy to determine the correct dose of warfarin. The international normalized ratio (INR) is used to quantify clotting factors and the efficacy of the dose.

Patients should be advised to continue eating a normal, healthy diet. Although some foods do affect the efficacy of warfarin, if patients eat a consistent diet each week the dose will be adjusted to the patient’s diet. Unusually high quantities of green leafy vegetables or grapefruit may change the how well warfarin works.

References

• http://www.nhs.uk/conditions/anticoagulants-warfarin-/Pages/Introduction.aspx
• http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682277.html
• https://health.ucsd.edu/specialties/anticoagulation/providers/warfarin/Pages/default.aspx
• http://www.nejm.org/doi/full/10.1056/NEJMoa1202299