Libman-Sacks Endocarditis Medication

Updated: Dec 23, 2014
  • Author: Xiushui (Mike) Ren, MD; Chief Editor: Richard A Lange, MD, MBA  more...
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Medication

Medication Summary

Anticoagulation with warfarin is often indicated for atrial fibrillation, mitral stenosis, mechanical heart valves, and thromboembolic events. High-dose anticoagulation is recommended for antiphospholipid syndrome. Anticoagulation may have a role in valvular disease treatment, based on case reports that valvular vegetations resolved after warfarin therapy in patients with antiphospholipid syndrome. However, therapeutic trials are lacking.

Outpatient follow-up considerations include monitoring of patients on anticoagulation therapy. Patient referral to an anticoagulation clinic may be appropriate.

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Anticoagulants, Hematologic

Class Summary

Indications for anticoagulation include atrial fibrillation, mitral stenosis, mechanical valves, thrombosis, thromboembolism, and antiphospholipid syndrome. Case reports have shown regression of valvular masses with the use of anticoagulation, although data are not conclusive. For anticoagulation, warfarin is used regularly.

Warfarin (Coumadin, Jantoven)

Warfarin is an oral anticoagulant that suppresses hepatic synthesis of vitamin K–dependent clotting factors. It is well absorbed orally, metabolized in the liver, and excreted in the urine and feces. Warfarin has a half-life of 0.5-1.5 day.

A loading regimen is usually used for initiation of therapy. Titrate the maintenance dose to the desired blood prothrombin time and international normalized ratio (INR); the desired INR depends on the indication for anticoagulation, the age of the patient, and the risks of bleeding versus thromboses. High-dose anticoagulation (INR 3-4) is usually indicated for antiphospholipid syndrome and mechanical valves. Warfarin is available in 1-, 2-, 2.5-, 5-, 7.5-, and 10-mg tablet sizes.

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