Warfarin is indicated for:

• Prophylaxis and treatment of venous thrombosis and its extension, pulmonary embolism
• Prophylaxis and treatment of thromboembolic complications associated with atrial fibrillation and/or cardiac valve replacement
• Reduction in the risk of death, recurrent myocardial infarction, and thromboembolic events such as stroke or systemic embolization after myocardial infarction 

Thrombosis

Pulmonary Embolism

Myocardial Infarction

Stroke

• Individualize dosing regimen for each patient, and adjust based on INR response.
• Knowledge of genotype can inform initial dose selection.

Monitoring:

• Obtain daily INR determinations upon initiation until stable in the therapeutic range. Obtain subsequent INR determinations every 1 to 4 weeks. 
• Review conversion instructions from other anticoagulants.

The following side effects have been reported with the use of Warfarin sodium-

• Hemorrhage
• Necrosis of skin and other tissues
• Systemic atheroemboli and cholesterol microemboli
• Urticaria
• Bruising
• Vasculitis
• Hepatitis

Hemorrhage

Urticaria

Hepatitis

Bruise

• Tissue necrosis: Necrosis or gangrene of skin or other tissues can occur, with severe cases requiring debridement or amputation. Discontinue Warfarin Sodium and consider alternative anticoagulants if necessary. 
• Systemic atheroemboli and cholesterol microemboli: Some cases have progressed to necrosis or death. Discontinue Warfarin Sodium if such emboli occur. 
• Heparin-induced thrombocytopenia (HIT): Initial therapy with Warfarin Sodium in HIT has resulted in cases of amputation and death. Warfarin Sodium may be considered after platelet count has normalized.
• Pregnant women with mechanical heart valves: Warfarin Sodium may cause fetal harm; however, the benefits may outweigh the risks. ]
• Patients taking warfarin should avoid activities that may increase the risk of bleeding, such as contact sports or heavy lifting.
• Patients should inform their healthcare provider of any signs or symptoms of bleeding, such as unusual bruising, bleeding gums, or blood in the urine or stool.
• Patients should inform their healthcare provider of any changes in their diet or medication regimen, as warfarin can interact with many drugs and certain foods.
• Patients should avoid alcohol and tobacco, as they can affect the metabolism of warfarin and increase the risk of bleeding.
• Warfarin Sodium can cause major or fatal bleeding.
• Perform regular monitoring of INR in all treated patients.
• Instruct patients about prevention measures to minimize risk of bleeding and to report signs and symptoms of bleeding.