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Inhibits reduction of vit K to active hydroquinone which is co-factor in carboxylation of factors 2,7 9 10 and protein C

''Indications''
VTE - target 2.5 unless recurrent then 3.5
AF - target 2.5
Mechanical heart valves - depends on type and location (mitral >aortic)

Monitour with INR - ratio of prothrombin of pt cf normal prothrombin
takes 3 days to stabilize

''Potentiating factors''
liver disease
P450 inhibitors - amiodarone, ciprofloxacin
cranberry juice
NSAID - displace warfarin from albumin and inhibit platelets

''SE''
Haemorrhage
teratogenicity (can be used for breast feeding)
skin necrosis (protein C reduced which gives pro-coagulant effect, avoided by also giving heparin. small thromboses in venules may cause skin necrosis)
purple toes