The Role of Warfarin in Anticoagulation Therapy: Current Insight’s and Clinical Perspectives

• Dr. Binju Mercy Oommen,  
• Dr. Niroja Umashankar*

Abstract

Warfarin is a widely used oral anticoagulant and vitamin K antagonist, essential for the prevention and treatment of venous thrombosis and thromboembolic complications. This review provides an in-depth examination of warfarin’s pharmacology, pharmacokinetics, pharmacodynamics, therapeutic monitoring, and drug-food interactions. Warfarin inhibits vitamin K-dependent clotting factors, leading to a controlled anticoagulation state, though achieving optimal dosing is complex due to its narrow therapeutic index. Monitoring via International Normalized Ratio (INR) is critical to balancing efficacy and safety. The pharmacokinetic profile of warfarin, which includes its racemic mixture and hepatic metabolism by cytochrome P450 enzymes, is further complicated by numerous drug-drug and drug-food interactions. These interactions often affect warfarin’s anticoagulant effect, necessitating individualized dosing and continuous INR monitoring. This review also highlights best practices for managing warfarin therapy, including the use of computer-assisted dosing systems and nomogram, and discusses strategies for mitigating adverse effects and maintaining therapeutic INR levels.

Keywords

Warfarin, Vitamin K antagonist, International Normalized Ration (INR), Warfarin therapy, Clotting factors