Warfarin vs Heparin
WarfarinHeparin
Vitamin K antagonistClassificationAnticoagulant (unfractionated heparin and low molecular weight heparin)
Inhibits the synthesis of vitamin K-dependent clotting factors (II, VII, IX, X).Mechanism of ActionActivates antithrombin III, which inhibits thrombin and Factor Xa.
OralRoute of AdministrationIntravenous (IV) or Subcutaneous (SC)
Slow (24-72 hours; full effect in 5-7 days)Onset of ActionRapid (within minutes when given IV)
Long (2-5 days; dependent on half-life of clotting factors)Duration of ActionShort (4-6 hours for IV; 12-24 hours for SC low molecular weight heparin)
Yes: INR (International Normalized Ratio)Monitoring RequiredYes: aPTT (activated Partial Thromboplastin Time) for unfractionated heparin; none for low molecular weight heparin (e.g., enoxaparin)
Vitamin K, Fresh Frozen Plasma (FFP), Prothrombin Complex Concentrate (PCC)Reversal AgentProtamine sulfate
Long-term prevention of thromboembolic events (e.g., atrial fibrillation, prosthetic heart valves, deep vein thrombosis [DVT], pulmonary embolism [PE])IndicationsAcute treatment of thromboembolic events (e.g., DVT, PE), during surgeries, or for bridging anticoagulation therapy
Contraindicated (teratogenic effects)Use in PregnancyPreferred anticoagulant in pregnancy (does not cross the placenta)
20-60 hours (high variability between individuals)Half-lifeUnfractionated heparin: 1-2 hours; Low molecular weight heparin: ~4-5 hours
Bleeding, skin necrosis, purple toe syndrome, teratogenic effectsSide EffectsBleeding, thrombocytopenia (including Heparin-Induced Thrombocytopenia [HIT]), osteoporosis with long-term use
Many (antibiotics, NSAIDs, antifungals, other anticoagulants, and foods high in vitamin K)Drug InteractionsFew compared to warfarin but still interacts with antiplatelet drugs and other anticoagulants
Generally lower (generic widely available)CostHigher (especially low molecular weight heparins like enoxaparin)
Fixed daily dosing based on INRDosingWeight-based dosing, often requires adjustments based on aPTT or anti-Xa levels
Requires consistent vitamin K intake (avoid sudden increases or decreases in green leafy vegetables)Dietary ConsiderationsNone required
Suitable for long-term use, oral administrationAdvantagesRapid onset, can be used in acute settings, safe in pregnancy
Requires frequent monitoring and dietary restrictionsDisadvantagesFrequent injections (for low molecular weight heparin), risk of HIT
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