The role of warfarin in anticoagulation therapy: Current insight’s and clinical perspectives

Warfarin, a widely used oral anticoagulant and vitamin K antagonist, plays a critical role in the prevention and treatment of venous thrombosis and thromboembolic complications. This review explores the pharmacological properties, pharmacokinetics, pharmacodynamics, therapeutic monitoring, and drug-food interactions of warfarin. By inhibiting vitamin K-dependent clotting factors, warfarin induces a controlled anticoagulation state. However, its narrow therapeutic index presents challenges in achieving and maintaining optimal dosing. Regular monitoring of the International Normalized Ratio (INR) is essential to ensure efficacy while minimizing risks. Warfarin's pharmacokinetics, characterized by its racemic mixture and metabolism, contribute to its sensitivity to drug-drug and drug-food interactions. These interactions often necessitate personalized dosing and close monitoring. This review emphasizes evidence-based strategies for warfarin management, including the application of nomogram, computer-assisted dosing systems, and protocols for handling adverse events. It underscores the importance of balancing therapeutic benefits with safety to optimize outcomes for patients undergoing warfarin therapy.