Aust Fam Physician
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Warfarin is a commonly used medication for the prevention and treatment of venous thromboembolism. It can be challenging for both the patient and the prescriber to manage at times. ⋯ The common indications for warfarinisation are atrial fibrillation, venous thromboembolism and prosthetic heart valves. Contraindications include absolute and relative contraindications, and an individualised risk-benefit analyses is required for each patient. There are many interactions with warfarin, including pharmacokinetic and pharmacodynamic. Pharmacokinetic interactions can be monitored by using International Normalised Ratio levels. Pharmacodynamic interactions require knowledge by the prescriber to predict any interactions with warfarin, and International Normalised Ratio monitoring assists.
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Pulmonary embolism remains a common and potentially preventable cause of death. ⋯ Well recognised risk factors include recent hospitalisation, other causes of immobilisation, cancer, and oestrogen exposure. Diagnostic algorithms for pulmonary embolism that incorporate assessment of pretest probability and D-dimer testing have been developed to limit the need for diagnostic imaging. Anticoagulation should be administered promptly to all patients with pulmonary embolism with low molecular weight heparin being the initial anticoagulant of choice, although thrombolysis is indicated for patients presenting with haemodynamic compromise. Following initial anticoagulation warfarin therapy should be continued for a minimum of 3 months. Long term anticoagulation with warfarin should be considered in patients with unprovoked pulmonary embolism, due to an increased risk of recurrence after ceasing anticoagulation. The availability of new anticoagulants is likely to significantly impact on the treatment of patients with pulmonary embolism, although the exact role of these drugs is still to be defined.