Active Ingredient: Warfarin
For this indication, competent medicine agencies globally authorize below treatments:
Oral
1 - 10 mg
From 1 To 10 mg once every day
10 mg
Whenever possible, base-line prothrombin time should be determined before the initial dose is given. An initial loading dose for warfarin is usually 10 mg daily for adults, tailored to individual requirements for the desired degree of anticoagulant effect. The maintenance dose is usually started after 48 hours and depends upon the prothrombin time-reported as international normalised ratio (INR). Currently recommended ranges of therapeutic anticoagulation are the following:
Prophylaxis of deep-vein thrombosis including surgery in high risk patients: INR 2-2.5.
Prophylaxis in hip surgery and fractured femur operations, treatment of deep vein thrombosis, pulmonary and systemic embolism, prevention of venous thromboembolism in myocardial infarction, transient ischaemic attacks, mitral stenosis with embolism, tissue prosthetic heart valves: INR 2-3.
Recurrent deep-vein thrombosis and pulmonary embolism, mechanical prosthetic heart valves, arterial disease including myocardial infarction: INR 3-4.5.
The daily maintenance dose, taken at the same time each day, is usually between 3 mg and 9 mg. In the early days of treatment, INR should be determined daily or on alternative days, then, depending on response, determinations should be at longer intervals and then, up to every 8 weeks.
In emergencies, anticoagulant therapy should be initiated with heparin and warfarin together. Concomitant therapy with heparin affects the results of control tests and should be discontinued at least six hours before the test is first carried out.
The elderly may be more susceptible to the effects of warfarin, resulting in increased risk of haemorrhage. Lower maintenance doses, weight for weight, than those usually recommended for adults may be required for these patients.
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