DrVirgo
Forum Hero
Topics: 1058
Posts: 3,383
|
When there is an indication to start Heparin in a diagnosed PE, do we start warfarin along with IV Heparin at the SAME TIME (according to UW) or ON THE SECOND DAY (according to Kap.)?
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| Miradautas Vras
Forum Senior
Topics: 8
Posts: 154
|
Same time.
___________________
Man who fights too long against the dragons becomes a dragon himself.
|
| liliaeliz
Forum Elite
Topics: 37
Posts: 342
|
WHY YOU START AT THE SAME TIME?
|
| arlete
Intern in 2009!!!!!
Topics: 30
Posts: 2,217
|
Because warfarin has a procoagulation effect during the first days. Heparin is given to act against it. It works faster, too.
___________________
When men make the rules, God decides the exceptions.
|
| mildus
Forum Guru
Topics: 19
Posts: 614
|
actually warfarin needs some time before starting to act; in the meantime, heparin is given to the patient
|
| mildus
Forum Guru
Topics: 19
Posts: 614
|
actually warfarin needs some time before starting to act; in the meantime, heparin is given to the patient
|
| mildus
Forum Guru
Topics: 19
Posts: 614
|
sorry for multiple posts, my browser didn't obey
|
| DrVirgo
Forum Hero
Topics: 1058
Posts: 3,383
|
Yes, I am aware that Warfarin inhibits the Vit K dependent clotting factors II, VII, IX, and X so it has an anticoagulant effect... However it also inhibits Protein C and S which are anticoagulants and have a shorter half life, so this can actually lead to COAGULATION initially -which is the opposite of what we want to accomplish in case of DVT/PE... This is why we give Heparin along with Warfarin for a few days until Warfarin has had time to work, and then D/C the Heparin and continue Warfarin.
My question here is about the details of WHEN we START Warfarin and Heparin. According to Kaplan they say Start Heparin on the first day, then on day two add warfarin.
And according to UW, they say to Start Heparin and Warfarin BOTH on the same day. Both are in agreement to continue Heparin and warfarin for 5 days or till INR is therapeutic.
Edited by DrVirgo on 03/17/08 - 02:12 PM
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| peter90036
Forum Elite
Topics: 28
Posts: 315
|
i think heparin acts very fast to stop coagulation - start immediately
and
warfarin takes a while - so why delay? -- start immediately
ok.
found in CMDT 2007 - warfarin start at same time
,
Harrison's says: "for most patients" start heparin and oral anticoag together, dc heparin day 5/6 if INR is therapeutic for 2 days.
NEJM Volume 358:1037-1052 March 6, 2008 Number 10
Acute Pulmonary Embolism
: when PE present -- initiate iv anticoag with LMWHeparin or fondaparinaux (what is this?!). warfarin can be initiated on the first day of therapy (meaning start of heparin)
Edited by peter90036 on 03/17/08 - 07:34 PM
|
| DrVirgo
Forum Hero
Topics: 1058
Posts: 3,383
|
peter90036 wrote:
fondaparinaux (what is this?!).
Hey, THANKS for confirming and looking it up
And yeah, what IS that??? -fondaparinaux???
___________________
Our greatest glory is not in never falling, but in rising every time we fall.
|
| farnsworth
Forum Newbie
Topics: 0
Posts: 165
|
fondaparinux is a FXa inhibitor, often used for thrombosis prophylaxis, give once a day subcutaneously.
|
| simi
Forum Elite
Topics: 53
Posts: 358
|
In my kaplan...it does not say on day 2....it says long term treatment with warfarin therapy should be started on day 1.
|
|
| |
| | | | | | | | | | | | |
