Last reviewed 06/2022
Warfarin is an anticoagulant agent that is usually used as the sodium salt.
Warfarin acts as a vitamin K antagonist so affecting the synthesis of active factors II, VII, IX, X and protein C. The therapeutic goal is to cause a partial inhibition of clotting factor synthesis, to prolong prothrombin time 2 to 4 fold.
Warfarin may be used in the treatment of established thromboembolism, for example a deep venous thrombosis diagnosed by venogram, but heparin is used until the effect of warfarin is optimal.
The warfarin dose should be titrated against measured INR, although the exact therapeutic range for the INR has not been well established.
There is no good evidence of rebound hypercoagulability on stopping warfarin.
Warfarin has many drug interactions. Look in the BNF. Note, amiodarone particularly.
In cases of warfarin overdose:
- infusion of fresh frozen plasma will provide a rapid correction of the coagulation disorder
- administration of vitamin K will correct the INR over a period of a few days but will interfere with subsequent warfarin treatment for several weeks
INR (suggested ranges and treatments)
reversal of oral anticoagulant therapy
risk of bleeding with combination of aspirin and warfarin
NICE guidance - warfarin (vitamin K antagonists) post myocardial infarction (MI)
combination treatment with aspirin and warfarin
assessing anticoagulation control with vitamin K antagonists