{"id":154,"date":"2017-11-25T07:01:54","date_gmt":"2017-11-25T01:31:54","guid":{"rendered":"http:\/\/cardiophile.org\/?p=154"},"modified":"2017-11-25T07:01:54","modified_gmt":"2017-11-25T01:31:54","slug":"changing-over-from-heparin-to-warfarin","status":"publish","type":"post","link":"https:\/\/johnsonfrancis.org\/professional\/changing-over-from-heparin-to-warfarin\/","title":{"rendered":"Changing over  from Heparin to Warfarin"},"content":{"rendered":"<h2><span style=\"color: #008000;\">Changing over &nbsp;from Heparin to Warfarin<\/span><\/h2>\n<p><iframe loading=\"lazy\" width=\"560\" height=\"315\" src=\"https:\/\/www.youtube.com\/embed\/dKkKje6Jzyk\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen=\"\"><\/iframe><br \/>\n<strong><span style=\"color: #0000ff;\">Abstract:<\/span>&nbsp;<\/strong><em>Heparin should be overlapped with warfarin till the INR is within therapeutic range, with a minimum of four days after initiation of warfarin therapy.<\/em><\/p>\n<p>It is usual practice to start heparin initially and then switch over to warfarin in many situations like peripheral embolism and pulmonary embolism. Sometimes warfarin is not initiated along with heparin when potential for a surgical intervention is considered in the near future because of the longer wane out period of warfarin effect. When such a possibility does not exist, warfarin can be initiated along with heparin so that duration of heparin therapy can be minimized. It may be noted that longer duration of heparin therapy not only increases the cost and pain associated with injections, but also the chance of the rare heparin induced thrombocytopenia syndrome (HIT). When a longer duration of parenteral anticoagulation is expected, it may be better to initiate low molecular weight heparin (LMWH), which has a more predictable bioavailability.<\/p>\n<p>The peak effect of a given dose of warfarin is reached in only about 96 hours, even if the INR (international normalized ratio of prothrombin time) is within the therapeutic range earlier than that. Hence a minimum heparin overlap period of four days is often considered mandatory while switching over from heparin to warfarin therapy [1]. Once the suggested therapeutic range of INR for the thrombotic condition being treated is achieved, heparin can be discontinued, after a minimum period of four days.<br \/>\nUsual target INR is 2-3 in most cases. INR of 2.5-3.5 is recommended in those with mechanical prosthetic valve at mitral position as well as those who have gone aortic and mitral valve replacement. If it is only aortic mechanical prosthesis, target INR is 2-3.<\/p>\n<p><strong><span style=\"color: #0000ff;\">Reference<\/span><\/strong><\/p>\n<ol>\n<li>J D Horton, B M Bushwick. <a href=\"https:\/\/www.aafp.org\/afp\/1999\/0201\/p635.html\">Warfarin therapy: evolving strategies in anticoagulation<\/a>. Am Fam Physician. 1999 Feb 1;59(3):635-46.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Heparin should be overlapped with warfarin till the INR is within therapeutic range, with a minimum of four days after initiation of warfarin therapy.<\/p>\n","protected":false},"author":1,"featured_media":41918,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"nf_dc_page":"","footnotes":""},"categories":[9],"tags":[],"class_list":["post-154","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-general"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Changing over from Heparin to Warfarin - overlap till INR in desirable range<\/title>\n<meta name=\"description\" content=\"Heparin should be overlapped with warfarin till the INR is within therapeutic range, with a minimum of four days after initiation of warfarin therapy.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/johnsonfrancis.org\/professional\/changing-over-from-heparin-to-warfarin\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Changing over from Heparin to Warfarin - overlap till INR in desirable range\" \/>\n<meta property=\"og:description\" content=\"Heparin should be overlapped with warfarin till the INR is within therapeutic range, with a minimum of four days after initiation of warfarin therapy.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/johnsonfrancis.org\/professional\/changing-over-from-heparin-to-warfarin\/\" \/>\n<meta property=\"og:site_name\" content=\"All About Cardiovascular System and Disorders\" \/>\n<meta property=\"article:published_time\" content=\"2017-11-25T01:31:54+00:00\" \/>\n<meta name=\"author\" content=\"Johnson Francis\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Johnson Francis\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/changing-over-from-heparin-to-warfarin\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/changing-over-from-heparin-to-warfarin\\\/\"},\"author\":{\"name\":\"Johnson Francis\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\"},\"headline\":\"Changing over from Heparin to Warfarin\",\"datePublished\":\"2017-11-25T01:31:54+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/changing-over-from-heparin-to-warfarin\\\/\"},\"wordCount\":316,\"publisher\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/#\\\/schema\\\/person\\\/5441d907049b914770f4bd98fb57feec\"},\"image\":{\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/changing-over-from-heparin-to-warfarin\\\/#primaryimage\"},\"thumbnailUrl\":\"\",\"articleSection\":[\"General Cardiology\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/changing-over-from-heparin-to-warfarin\\\/\",\"url\":\"https:\\\/\\\/johnsonfrancis.org\\\/professional\\\/changing-over-from-heparin-to-warfarin\\\/\",\"name\":\"Changing over from Heparin to Warfarin - 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