Warfarin is used both on an inpatient and outpatient basis when long-term anticoagulant therapy is indicated. The onset of anticoagulation is delayed, the latency being determined in part by the time required for absorption and in part by the half-lives of the vitamin K-dependent hemostatic proteins. The anticoagulant effect will not be evident in coagulation tests such as prothrombin time until the normal factors already present in the blood are catabolized; this takes 5 hours for factor VII and 2 to 3 days for prothrombin (factor II). The anticoagulant effect may be preceded by a transient period of hypercoagulability due to a rapid decrease in protein C levels. More rapid anticoagulation is provided, when necessary, by administering heparin.
Warfarin is administered in conventional doses or minidoses to reduce bleeding. The dose range is adjusted to provide the desired end point.
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