The most frequently reported adverse effect of all oral anticoagulants is haemorrhage. Patients with protein S deficiency may also be at risk and it is advisable to introduce warfarin therapy slowly in these circumstances. In patients with protein C deficiency therapy should be introduced without a loading dose of warfarin even if heparin is given. Patients with protein C deficiency are at risk of developing skin necrosis when starting warfarin treatment. Patients for whom adherence may be difficult should be monitored more frequently. patients with severe hypertension, liver or renal disease. INR should be monitored more frequently in patients at an increased risk of over coagulation e.g. Once the INR has stabilized in the target range the INR can be determined at longer intervals. When warfarin is started using a standard dosing regimen the INR should be determined daily or on alternate days in the early days of treatment. Patients should be given a patient-held information booklet ('warfarin card') and informed of symptoms for which they should seek medical attention. Most adverse events reported with warfarin are a result of over anticoagulation therefore it is important that the need for therapy is reviewed on a regular basis and therapy discontinued when no longer required. Paediatric population: No data are available. Where there is less urgency, as in patients disposed to or at special risk of thromboembolism, anticoagulant therapy may be initiated with warfarin alone.Ĭoncomitant heparin therapy affects the results of control tests and should be discontinued at least six hours before the first test is carried out.Ĭontrol is established with INR monitoring at regular intervals and subsequent warfarin maintenance dosage further adjusted according to the results obtained. In emergencies, anticoagulant therapy should be initiated with heparin and warfarin together. Once the maintenance dose is stabilised in the therapeutic range, it is rarely necessary to alter it. The maintenance dose is omitted if the prothrombin time is excessively prolonged. The exact maintenance dose for an individual is dependent on the prothrombin time or other appropriate coagulation tests. The daily maintenance dose of warfarin is usually 3 to 9 mg taken at the same time each day. Baseline prothrombin measurements (PT) should be taken before beginning therapy with warfarin. Date of first authorisation/renewal of the authorisationĪdults and elderly patients: The typical induction dose of warfarin is 10 mg daily for 2 days, but this should be tailored to individual requirements. 6.6 Special precautions for disposal and other handling.4.7 Effects on ability to drive and use machines.4.5 Interaction with other medicinal products and other forms of interaction.4.4 Special warnings and precautions for use.4.2 Posology and method of administration.Show table of contents Hide table of contents
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