warfarin for VTE prophylaxis

[hopeinternist]

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FA 2013 says warfarin inhibits factors 2,7,9,10 protein C and S. Uworld says only 2,7,9,10. thoughts? uptodate says to include C and S. Hard to believe uworld omitted information but just wanted to make sure I had it clear 🙂 Thanks .

 

[calvnandhobbs68]

FA 2013 says warfarin inhibits factors 2,7,9,10 protein C and S. Uworld says only 2,7,9,10. thoughts? uptodate says to include C and S. Hard to believe uworld omitted information but just wanted to make sure I had it clear 🙂 Thanks .

Definitely C and S as well, it's the reason you get warfarin skin necrosis.

 

[MLT2MT2DO]

FA 2013 says warfarin inhibits factors 2,7,9,10 protein C and S. Uworld says only 2,7,9,10. thoughts? uptodate says to include C and S. Hard to believe uworld omitted information but just wanted to make sure I had it clear 🙂 Thanks .

UW isn't exactly the bible...in fact if I had to pick between only ONE resource, I'd probably pick FA over UW.

With that said yeah Protein C and S also...one of the few nitty gritty things I remember reading out of Big Guyton's

 

[hopeinternist]

thanks!

 

[CaptainSSO]

Definitely C and S as well, it's the reason you get warfarin skin necrosis.

Also the reason it's good to heparinize a patient for a couple days before giving warfarin...otherwise they can be prone to thromboembolism since without C and S they can't cleave factors 5 and 8.

 

[Greenbayslacker]

Also the reason it's good to heparinize a patient for a couple days before giving warfarin...otherwise they can be prone to thromboembolism since without C and S they can't cleave factors 5 and 8.

I thought you give heparin before warfarin because there is a delay in the onset of warfarin's effects, since it is basically affected NEW gamma-carboxylation, and there will still be some active coag factors around; heparin on the other hand goes to work with ATIII immediately. or is it both reasons?

 

[CaptainSSO]

I thought you give heparin before warfarin because there is a delay in the onset of warfarin's effects, since it is basically affected NEW gamma-carboxylation, and there will still be some active coag factors around; heparin on the other hand goes to work with ATIII immediately. or is it both reasons?

Yea, no you're right, it is both.

Edit: apparently you also only need to wait a couple hours before adding warfarin I said a few days