Coumadin
Coumadin
Coumadin (Warfarin)Pharmacological action
Anticoagulant of indirect action. Blocks in a liver synthesis vitamin of K-dependent factors of coagulation of blood, namely - II, VII, IX and H.Kontsentratsija of these components in blood decreases, process of coagulation of blood is slowed down.
Optimum anticoagulative action is observed for 3-5 day from the beginning of application of a preparation, and stops in 3-5th days after reception of last dose.
Coumadin Indications
Treatment and preventive maintenance of clottages and embolisms of blood vessels, including:
- An acute venous clottage and an embolism of a pulmonary artery (in a combination with a heparin);
- A postoperative clottage;
- A repeated myocardial infarction;
- At carrying out of surgical or thrombolytic treatment of clottages and at carrying out of electric cardioversion of an atrial fibrillation (as additional therapy);
- A relapsing venous clottage;
- A repeated embolism of a pulmonary artery;
- Presence of prostheses of valves of heart or blood vessels (including in a combination with Acidum acetylsalicylicum);
- A clottage of peripheric, coronary and cerebral arteries.
Preparation apply to secondary preventive maintenance of a clottage and a thromboembolism after a myocardial infarction and at an atrial fibrillation.
Dosage regimen. Coumadin diet
To patients to whom the surgical intervention, a preparation recommend to prescribe 2-3 days prior to operation.
The initial dose of a preparation makes 2 mg/days
The further regimen of dosage establish individually depending on a prothrombin time or an indicator of coagulation of blood - the International normalised relation. The Prothrombin time should be enlarged in 2-4 times from initial, danger of a clottage, risk of development of bleedings and specific features of the patient.
Further spend regular (each 4-8 weeks) the control.
To persons of advanced age and the weakened patients a preparation usually prescribe in lower doses.
The full daily dose should be accepted in one step and at a time days.
At prosthetics of valves of heart, an acute venous clottage, primary embolisms, clottages of a left ventricle.
Duration of a course of therapy depends on a clinical condition of the patient. Treatment can be cancelled at once.
Coumadin Side effect
From coagulating system of blood: often - a staxis.
From the alimentary system: seldom - a diarrhoeia, rising of activity of hepatic enzymes.
Dermatological reactions: seldom - an eczema, a skin necrosis, vasculites, abaissement of hair.
Coumadin Contraindications
- Pregnancy;
- Serious diseases of kidneys;
- Serious diseases of a liver;
- A serious arterial hypertensia.
Pregnancy and lactemia
Warfarin is allocated with thoracal milk in insignificant quantity and does not render influence on processes of coagulation of blood at the baby. Hence, the preparation can be applied during thoracal feeding, but for full safety it is recommended to refrain from feeding by a breast within first three days of treatment of mother a preparation.
Coumadin Special indicatings
Patients should be warned about necessity of strict observance of the recommended regimen of dosage of a preparation.
It is not necessary to prescribe Coumadin to patients with a bleeding of any localisation.
With extra care prescribe a preparation at disturbances of processes of coagulation of blood, a thrombocytopenia, at a stomach and duodenum peptic ulcer in an exacerbation phase, at disturbances of function of kidneys, hemorrhages in a brain and a sick alcoholism.
Coumadin Overdosage
The therapy optimum level is on border of development of bleedings, therefore the patient can have insignificant bleedings (for example, a microhematuria, a staxis of gums). If the patient does not have reasons of development of bleedings (for example, an urolithiasis), serious danger from such bleeding is not present until the prothrombin time makes more than 5 %.
Treatment: in easy cases it is enough to lower a dose of a preparation or to stop treatment for short term. At serious bleedings prescribe an antidote - small doses of vitamin K until indicators of coagulation of blood will not reach comprehensible level. At danger of development of bleedings menacing to a life immediate transfusion of concentrates of factors of a prothrombin complex or integral blood is necessary.
Coumadin Medicinal interaction
The patient should be warned about necessity of consultation of the doctor before the beginning or the termination of reception of other medical products, and also change of a dose of simultaneously applied preparations.
Coumadin Conditions and periods of storage
The preparation should be stored in a place inaccessible to children at temperature not above 25 C. The Period of validity - 5 years.
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