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Warfarin PowerPoint Presentation

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Description : Check out this medical presentation on Anticoagulant, which is titled "Warfarin", to know about the mechanism of action, indications, contraindications, adverse reactions, & common drug interactions of warfarin. This presentation also lets you know how to use vitamin K1 appropriately.

Tags : Anticoagulant, Warfarin, drug interactions, vitamin K1

Published on : May 25, 2021 | Views : 4165 | Downloads : 4

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Slide 1-

Margaret Jin, BScPHM, PharmD, CGP November 2007
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Learning Objectives To review the mechanism of action, indications, contraindications, adverse reactions, & common drug interactions of warfarin To provide effective patient education To understand general concepts in warfarin dosing To be able to use vitamin K1 appropriately
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Warfarin Synthesis of Non Functional Coagulation Factors Antagonism of Vitamin K Mechanism of Action Vitamin K VII IX X II
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Mechanism of Action Clotting Cascade
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Indications & Recommended Therapeutic Range Chest 2004;126(3 Suppl):204S-233S
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Contraindications Pregnancy Risk of hemorrhage > clinical benefits Active hemorrhage (e.g., GI bleed) Uncontrolled alcohol/drug abuse Unsupervised dementia/psychosis Unable to monitor INR
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Adverse Effects A/E to report to MD: Blood in stools or urine Excessive menstrual bleeding Bruising Excessive nose bleeds/bleeding gums Persistent oozing from superficial injuries Intracranial Hemorrhage Factors that may influence bleeding risk: Intensity of anticoagulation Concomitant clinical disorders Hx of bleeding Hx of stroke Renal/Liver insufficiency Anemia Hypertension Concomitant use of other medications Chest 2004;126(3):204S-233S
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Adverse Effects Skin necrosis – 0.01-0.1% Day 3 – 8 Painful skin lesions Purple toe syndrome Week 3 – 8 Blue/purple toes/fingers Allergic Dermatitis Skin rash, hives, itching Vasculitis Fever, itching, skin sores or blisters
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Pharmacokinetics Absorption Rapid absorption Food does not affect absorption Distribution 99% protein bound Metabolism Liver Cytochrome P450 2C9
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Drug Interactions Increase Warfarin Response NSAIDS, ASA Acetaminophen > 2g/d Amiodarone Quinolones (e.g., Cipro), sulfonamides, metronidazole Fibrates Ginkgo, Garlic, Ginseng Grapefruit Decrease Warfarin Response Phenobarbital Carbamazepine Phenytoin Vitamin K rich foods Green leafy vegetables
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Effective Patient Education Teach basic concepts of safe, effective anticoagulation Discuss importance of regular INR monitoring Counsel on use of other medications, alcohol Develop creative strategies for improving compliance Evening, same time Dosettes, blisterpacks
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Warfarin Tablets 1mg – pink 2mg – lavendar 2.5mg – green 3mg – tan 4mg – blue 5mg – peach 6mg – teal 7.5mg – yellow 10mg - white
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Warfarin Maintenance Target INR 2.0 - 3.0 ^If INR is 1.8 to 1.9, consider no change with repeat INR in 7 to 14 days *If INR is 3.1 to 3.2, consider no change with repeat INR in 7 to 14 days
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Warfarin Maintenance Target INR 2.5 - 3.5 ^If INR is 2.3 to 2.4, consider no change with repeat INR in 7 to 14 days *If INR is 3.6 to 3.7, consider no change with repeat INR in 7 to 14 days
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Mon Tue Wed Thu Fri Sat Sun Total Weekly Dose 21 mg 2 2 19 mg 2 2 2 18 mg Warfarin Dosing Schedule  10%  15%
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Mon Tue Wed Thu Fri Sat Sun Total Weekly Dose 21 mg 4 4 23 mg 4 4 4 24 mg Warfarin Dosing Schedule  10%  15%
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Types of Bleeds No significant bleeding = Minor bleeding Bruises Reported, but does not require additional testing, referrals or visits Serious bleeding = Major bleeding Black tarry stools, blood in urine, hematoma Requiring treatment, medical evaluation or at least 2 units of blood Life-threatening bleeding Intracranial hemorrhage, retroperitoneal bleed, leading to cardiac arrest, surgical/angiographic intervention, or irreversible sequelae
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Warfarin Management *High risk = factors that may influence bleeding risk - Hx of bleeding, stroke, renal & liver insufficiency, anemia, hypertension, other medications
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Warfarin Management
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Warfarin Management Serious bleeding, any INR Hold Warfarin Give Vitamin K1 10mg slow IV plus fresh plasma or prothrombin complex concentrate, depending on urgency Repeat Vitamin K1 every 12 hours as needed Life-threatening bleeding, any INR Hold warfarin Give prothrombin complex concentrate (or recombinant factor VIIa as an alternative) supplemented with vitamin K1 10mg slow IV; repeat as needed
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Vitamin K1, Phytonadione Injection Formulation 10mg/mL – 1mL vial 2mg/mL – 1mL vial Tablets are not available in Canada Administer PO or IV Do not administer SC Elimination Half-life = 26-193 hours
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Summary Use clinical judgment Educate patient Adjusting warfarin dose is better than adjusting patient’s quality of life Monitor INR appropriately Refer to Thrombosis Clinic if necessary
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References The Thrombosis Interest Group of Canada (www.tigc.org) Vitamin K diet www.gicare.com/pated/edtot39.htm http://www.drgourmet.com/warfarin/vitaminkcontent.pdf Ansell J, et al. The pharmacology and management of the vitamin K antagonists. Chest 2004;126:204S-233S Singer DE, et al. Antithrombotic therapy in atrial fibrillation. Chest 2004;126:429S-456S http://www.ccs.ca/download/consensus_conference/consensus_conference_archives/2004_Atrial_Fib_full.pdf
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Questions