• Pro:
  • good for mitral valve conditions & renal conditions,
  • lower cost
• Con:
  • slow (take several dys)
  • unsafe for pregnancy, esp week 9-12
  • dosage unpredicatble, variable, labile - need lab monitoring

Antidote:

• Vitamin K infusion

Monitoring:

• PT/INR (<1)
  • Purpose: Monitors the anticoagulant effect of warfarin
  • Target range:
    • 2.5 (2.0–3.0) for most conditions (e.g., atrial fibrillation, DVT, PE)
    • 3 (2.5–3.5) for mechanical heart valves or high-risk situations
  • Frequency:
    • Daily to every few days when initiating or adjusting the dose
    • Every 1–4 weeks once stable

“Be CALM” → Indication

• Breastfeeding - aim for INR 2-3 (LMWH also okay!)
• **CKD stage 4/5 (**NB this is evolving)
• Antiphospholipid Antiboty syndrome
• LV thrombus
• Mechanical Valve
  • INR 2.5-3.5
  • mitral, 2-3 aortic

Peri-operative Management

• Surgery Pre-op Risk Assessment and Optimization