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What are the CIs for warfarin (some may be relative) - name 5.
- Pregnancy
- Bleeding diathesis
- Bleeding ulcer
- Alcoholism/psychosis
- Hypersensitivity
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Explain the procedure of starting warfarin?
- Kept as inpatient
- Heparin cover for 5 days
- Starting dose 5-10mg PO for 2 days then adjust dose according to INR (2-10mg)
- Lag period of 2-3 days
- INR target is 2-3
- GP or anticoag clinic arrangement
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What are the risks of warfarin?
- Haemorrhage (2-3%) - only common one!
- GI upset
- Fever
- Skin necrosis - usually appears few days of starting
- Hypersensitivity
- Hepatic dysfunction
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What are the drug-drug interactions of warfarin?
- NSAIDS and paracetamol: enhance effect
- COCP: decrease effect
- Alcohol:decrease effect
- Natural products: St John's warts, garlic, ginger
- Vitamin E: enhance effect
- Foods: high in vit K can decrease its effect e.g. livers, green tea
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