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The major side effect of warfarin use is bleeding. Risk of bleeding is increased if the INR is out of range (due to accidental or deliberate overdose or due to interactions). [45] Many drug interactions can increase the effect of warfarin, also causing an overdose. [27]
The monitoring of warfarin and keeping the international normalized ratio (INR) between 2.0 and 3.0, along with avoiding over and under treatment, has driven a search for an alternative. [3] [14] A naturally occurring inhibitor of factor Xa was reported in 1971 by Spellman et al. from the dog hookworm. [15]
The INR test measures the time it takes for a clot to form in a blood sample relative to a standard. An INR value of 1 indicates a level of coagulation equivalent to that of an average patient not taking warfarin, and values greater than 1 indicate a longer clotting time and, thus, a longer bleeding time. Assessing bleeding risk
The INR is typically used to monitor patients on warfarin or related oral anticoagulant therapy. The normal range for a healthy person not using warfarin is 0.8–1.2, and for people on warfarin therapy an INR of 2.0–3.0 is usually targeted, although the target INR may be higher in particular situations, such as for those with a mechanical ...
Dabigatran is an oral direct thrombin inhibitor. Dabigatran (Pradaxa) was found to be noninferior to Warfarin in prevention of ischemic stroke, as well as intracranial hemorrhage risk and overall mortality for non-valvular atrial fibrillation according to the RE-LY trial. [9]
An antithrombotic agent is a drug that reduces the formation of blood clots (). [1] [2] Antithrombotics can be used therapeutically for prevention (primary prevention, secondary prevention) or treatment of a dangerous blood clot (acute thrombus).
They are categorised as "first-generation" anticoagulants, and have similar effects as warfarin. They have been largely superseded by second-generation anticoagulants because warfarin-resistant rodents have become more common. [6] Anisindione, fluindione, and phenindione are oral anticoagulant medicines with actions similar to warfarin. However ...
For both drugs, the INR needs to be carefully monitored. Both are racemates, and the S(−)-enantiomers are significantly more potent than the respective R(+)-enantiomers. There are however pharmacokinetic differences: Warfarin is predominantly metabolized via the enzyme CYP2C9, while for phenprocoumon CYP3A4 plays the more important role. The ...
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