A novel anticoagulant using RNA aptamer technology in early development is hoped to overcome many of the limitations of current agents, in that it is selective, has a rapid onset of action, can be easily titrated, and is fully reversible with the use of an antidote. (Dyke CK et al. Circulation 2006; published online before print November 13, 2006. American Heart Association 2006 Scientific Sessions.)

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ANY HEAD INJURY, NO MATTER HOW SLIGHT IT MIGHT SEEM AT THE TIME, IS CAUSE FOR CONCERN WHEN A PERSON IS TAKING WARFARIN. THIS DOES NOT MEAN THAN AN AMBULANCE RIDE TO THE HOSPITAL IS ALWAYS NECESSARY. IN FACT, IT MAY TAKE UP TO A WEEK FOR THERE BE ANY INDICATION OF A BRAIN INJURY. IT IS POSSIBLE TO HAVE TESTS DONE TOO SOON AFTER THE INJURY WHICH CAN LEAD TO A FALSE SENSE OF SECURITY. CLOSE OBSERVATION FOR A LONG PERIOD OF TIME MAY BE NECESSARY. DO NOT OVERLOOK THE FACT THAT A BRAIN INJURY MAY CAUSE THE INJURED PERSON TO DEVELOP POOR JUDGMENT CAUSING THEM TO NOT RELATE THEIR CONDITION TO SIGNIFICANT OTHERS. Last modified August 29, 2004

Chest , Sept.. 2004 (Suppl) Notes: 1. These indications and recommended intensities of treatment are derived from the Seventh American College of Chest Physicians Consensus Conference (2004). 2. For most indications a therapeutic range of 2.0 to 3.0 is recommended. A higher INR range of 2.5 to 3.5 is recommended for parents with mechanical prosthetic valves and post myocardial infarction and for some patients with antiphospholipid syndrome and a history of thrombosis.

© 2003. The Journal of Rheumatology Publishing Company Limited. Patients can tell when their INR is off.

National Heart, Lung, and Blood Institute (NHLBI)- February 24, 2003 A study of long-term, low-dose warfarin to prevent the recurrence of the blood clotting disorders deep vein thrombosis (DVT) and pulmonary embolism resulted in such a high degree of benefit to the patients — without significant adverse effects — that the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health has stopped the study early.

Warfarin Institute of America

Articles about a variety of topics concerning warfarin use

All of the medications listed on this page interact with warfarin.

Last Updated: August 24, 2005. Article by John C Stein, Jr, MD

Published in the American Family Physician, Feb. 1999. A good general article, promotes an INR of 3-4 for APS patients.

US Pharm. 2007;32(3):34-38. Clinicians continue to find warfarin challenging to prescribe, despite its widespread use. Through the use of technology to determine genetic information, future personalizing or tailoring of warfarin dosing is estimated to save over a billion health care dollars in the U.S. each year. Researchers recommend that genetic analysis of VKORC1 be an essential component of future prospective studies focusing on investigating the value of genotyping for warfarin therapy. Prospective, clinical study is now underway at multiple study sites. As scientists accumulate more evidence and a better understanding of the genes associated with varied medication responses, additional testing methods for relevant gene variants will be developed. Pharmacogenetics will eventually shift from the laboratory to clinical practice, with the goal of tailored dosing based on a patient's individual characteristics.

Henry I. Bussey, Pharm.D., FCCP, FAHA March, 2007

Thrombosis Journal 2005, 3:20 doi:10.1186/1477-9560-3-20

Warfarin Institute of America

Last updated January 1, 2006

Am Fam Physician 2007;75:1031-42. Copyright © 2007 American Academy of Family Physicians. The Seventh American College of Chest Physicians (ACCP) Conference on Antithrombotic and Thrombolytic Therapy provides guidelines for outpatient management of anticoagulation therapy. The ACCP guidelines recommend short-term warfarin therapy, with the goal of maintaining an International Normalized Ratio (INR) of 2.5 ± 0.5, after major orthopedic surgery. Therapy for venous thromboembolism includes an INR of 2.5 ± 0.5, with the length of therapy determined by associated conditions. For patients with atrial fibrillation, the INR is maintained at 2.5 ± 0.5 indefinitely; for most patients with mechanical valves, the recommended INR is 3.0 ± 0.5 indefinitely. Use of outpatient low-molecular-weight heparin (LMWH) is as safe and effective as inpatient unfractionated heparin for treatment of venous thromboembolism. The ACCP recommends starting warfarin with unfractionated heparin or LMWH for at least five days and continuing until a therapeutic INR is achieved. Because patients with venous thromboembolism and cancer who have been treated with LMWH have a survival advantage that extends beyond their venous thromboembolism treatment, the ACCP recommends beginning their therapy with three to six months of LMWH. When invasive procedures require the interruption of oral anticoagulation therapy, recommendations for bridge therapy are determined by balancing the risk of bleeding against the risk of thromboembolism. Patients at higher risk of thromboembolization should stop warfarin therapy four to five days before surgery and start LMWH or unfractionated heparin two to three days before surgery.

To put it simply, warfarin increases the amount of time your blood takes to clot; therefore, if a person gets a tattoo while taking warfarin, it may bleed longer and take longer to heal. ©2006 Rebecca Muñiz

February, 2006

NEJM article describing the results of the PREVENT clinical trial.

Agency for Healthcare Research and Quality, Rockville, MD.

Recurrent Systemic Embolism: In cases where the risk of thromboembolism is great, such as in patients with recurrent systemic embolism, a higher INR may be required. An INR of greater than 4.0 appears to provide no additional therapeutic benefit in most patients and is associ-ated with a higher risk of bleeding.