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Old 11-09-2012
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Default warfarin in Afib q

do we give heparin cover prior to w therapy in afib ?


any new concept why no ?...conrad says no !!! in mtb2
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Old 11-09-2012
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Originally Posted by tyagee View Post
do we give heparin cover prior to w therapy in afib ?


any new concept why no ?...conrad says no !!! in mtb2
Depends man, if the a fib is chronic > than 48 hours you have to anticoagulate.

The management of afib focuses more on rate control rather than rhythm control
If the afib is acute and only a single episode like triggered by binge drinking in a young male or drinking to much caffeine in an executive then you can cardiovert, either with drugs or with electrical cardioversion depending if there is hemodynamic instability
If they afib is chronic or caused by another comorbidity you have to use the
CHADS2 scale to see wether you are gonna anticoagulate with warfarin or with aspirin
CHF
HTN
Age >75
DM
Stroke

All of them get one point except prior history of stroke which gets 2, if you have 1 or zero points you give aspirin, if you have 2 or more you get warfarin

Rate control is managed with BB and Calcium channel blockers
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Also if the afib is less than 48 hours you dont anticoagulate, if it is more than 48 hours and you want to cardiovert the you have to anticoagulate first, because if not when you restore norma, rhythm you are gonna stroke the poor fella
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Old 11-09-2012
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Originally Posted by tyagee View Post
do we give heparin cover prior to w therapy in afib ?


any new concept why no ?...conrad says no !!! in mtb2

Warfarin should not be given alone initialy as it can cause skin necrosis.

Warfain causes inactication of factors II, VII, IX and X, Protein C and Protein S..
Of these factors those with low half life are delpleted first...That is Factor C and Facor VII...

Inactivation of Factor C which is an anticoagulant action causes paradoxical hypercoagulation hence thrombosis and skin necrosis..

To prevent this it should be covered with heparin, which has a different mechanism of action . till warfarin inactivates all other factors ie for 1 week.
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Warfarin should not be given alone initialy as it can cause skin necrosis.

Warfain causes inactication of factors II, VII, IX and X, Protein C and Protein S..
Of these factors those with low half life are delpleted first...That is Factor C and Facor VII...

Inactivation of Factor C which is an anticoagulant action causes paradoxical hypercoagulation hence thrombosis and skin necrosis..

To prevent this it should be covered with heparin, which has a different mechanism of action . till warfarin inactivates all other factors ie for 1 week.
That is true but I think it is not routinely done in clinical practice unless patient requires immediate anticoagulation or you suspect a congenital Protein C deficiency.
MTB 2 page 554 says that Heparin is not necessary before starting a patient on Warfarin.
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