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Warfarin works by competitively inhibiting the enzyme vitamin K epoxide reductase complex 1 (VKORC1), which is vital for activating vitamin K in the body. This action reduces available functional vitamin K and hinders the synthesis of active clotting factors. Clotting factors II, VII, IX, and X, as well as regulatory factors protein C and protein S, all crucial for coagulation, rely on vitamin K.
Warfarin is taken orally once a day, preferably in the afternoon or evening. This timing allows healthcare providers to adjust doses based on the latest lab results. Due to varying patient responses, factors like metabolism, diet, genetics, clotting factor levels, health conditions, drug interactions, and adherence impact warfarin's effectiveness.
Summary of recommendations by NICE CKS
| Condition | Duration of Warfarin Treatment |
|---|---|
| Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) | • Six weeks for distal DVT (calf vein thrombosis). |
| • Three months for proximal DVT or PE with known temporary risk factors and low risk of recurrence. | |
| • Six months for proximal DVT of unknown cause (idiopathic). | |
| • Long term if there are recurrent DVTs or PEs. | |
| Atrial Fibrillation (AF) | • Usually long term treatment. |
| • Achieve target INR at least 3 weeks before and 4 weeks after... |
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