TABLE 2161 Antithrombotic Therapy Guidelines

Sodium warfarin, a hydroxycoumarin compound, is the most widely used oral anticoagulant in North America. Readily absorbed from the gut, it reaches peak blood concentrations in 90 min and has a circulating half-life of 36 to 42 h. Warfarin blocks activation of vitamin K and thereby interferes with hepatic carboxylation of coagulation factors II, VII, IX, and X (Fig...216-1). Without these vitamin K-dependent cofactors, the extrinsic pathway of thrombus formation is blocked. Warfarin also blocks the synthesis of proteins C and S, which work together to inhibit the function of factors V and VII in the coagulation cascade. Warfarin dosing is guided by the international normalized ratio (INR), a standardized measurement of prothrombin time (PT), with a desired therapeutic range of 2.0 to 2.5 in most cases. 3 Drugs and food that interfere with warfarin absorption or hepatic metabolism can have a profound effect on warfarin activity ( T,a,b.!e,.2..,1,6.-.2.).4

FIG. 216-1. Clotting factors and tests of coagulation.

FIG. 216-1. Clotting factors and tests of coagulation.

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