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Heparin warfarin use

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Critical Evaluation of Methods for Therapeutic Drug Monitoring

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3 (pulmonary embolism, PE)(deep venous thrombosis, DVT)

4Kenneth, AB. Overveiw of the causes of venous thrombosis. In: UpToDate, Geraldine, F (Ed), UpToDate,Waltham, MA, 2013

5Ref: the 2012 ACCP evidence-based clinical practice guidelines for antithrombotic and thrombolytic therapy Chest. 2012;141(2 Suppl):e419S

PEDVTLow molecular weight heparin (LMWH)Unfractionated intravenous heparinFondaparinux (Factor Xa inhibitor)Adjusted dose subcutaneous heparin6

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HeparinLMWH8

Ref: Harrison's Principles of Internal Medicine - 17th Ed. (2008) antithrombin thrombinthrombinantithrombin factor aa

unfractionated heparin (UFH)antithrombin thrombinthrombinantithrombin factor a8

(Low Molecular Weight Heparin, LMWH)Enoxaparin TinzaparinDalteparinNadroparinArdeparinReviparin

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Ref: Tapson VF. Treatment of acute pulmonary embolismIn: UpToDate, Wilson KC (Ed), UpToDate, Waltham, MA, 2013.

Enoxaparin (Clexane)/: 9,10,11,12// (SQ/IVIM): 1 mg/kg (75 mg) SC Q12H:: 40 mg SC QD: 1 mg/kg SC Q12H:GFR 40 5 mg/dayfactor VIIfactor IIINRUFHLMWH

19Ref: Valentine, KA. Therapeutic use of werfarin. In: UpToDate, Landaw, SA. (Ed), UpToDate, Waltham, MA, 2013.

Warfarin5 mg/dayINRINR1-21-22-4INR2-3

20Ref: Valentine, KA. Therapeutic use of werfarin. In: UpToDate, Landaw, SA. (Ed), UpToDate, Waltham, MA, 2013.

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Warfarin (aspirin, clopidogrel) (NSAIDs)vitamin K ()warfarin (C, azathioprine)warfarin (amiodarone, rifampin) (: : )vitamin K (acetaminophen)

22Ref: Valentine, KA. Therapeutic use of werfarin. In: UpToDate, Landaw, SA. (Ed), UpToDate, Waltham, MA, 2013.

warfarin23

Warfarin24

Wafarin INR?UpToDateACCP 20129warfarin(2.5-5 mg)vit KINRINRwarfarinINRwarfarinslow IV infusion (10 mg)vit KFFPprothrombin complex concentrationINRINRwarfarin

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Warfarin(K)Warfarin INRINR: international normalized ratio

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28DabigatranRivaroxabanApixabanWarfarinThrombinFactor XaFactor XaVitamin K dependent coagulation factor6%66-100%>50%>95%0.5-22-41-49012-1498-1336-4280%66%25%92%35%90%90%99%P-gp P-gpCYP3A4P-gpCYP3A4CYP2C9, 1A2, 3A4()(PCCs)(PCCs)PCCsFFPvitamin KFFP-fresh frozen plasma, PCCs-prothrombin complex concentrates, P-gp-P-glycoprotein

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