Global Journal of Science Frontier Research, G: Bio-Tech & Genetics, Volume 22 Issue 2

3. Vitamin K deficiency because of insufficient vitamin K diet or antibacterial therapy, which suppresses intestinal flora 4. Low concentrations of coagulation factors such as liver failure, heart failure, and the hypermetabolic state as in hyperthyroidism Relative contraindications of warfarin potassium therapy • Pregnancy • Situations where the risk of bleeding is greater than the clinical benefits of therapy • Uncontrolled alcohol and drug abuse • Unsupervised dementia or psychosis • Severe hepatic disease and gastrointestinal tract bleeding • Sub-acute bacterial endocarditis • Recent head trauma or recent major surgery Thrombolytics promote the dissolution of thrombi in occluded blood vessels through a fibrinolytic effect. They are described mainly for acute myocardial infarction. Fibrinolytic drugs rapidly dissolve thrombi by catalyzing the plasmin formation from plasminogen, so they are plasminogen activators. These drugs create a fibrinolytic state when administered intravenously; thus, they are both protective and curative. They are given as a bolus or by intravenous infusion. Examples of these drugs are streptokinase and urokinase which is a human enzyme synthesized by the kidney, which converts plasminogen into plasmin. Character Heparin Warfarin Potassium Effectiveness In vivo and in vitro In vivo only Route of administration I.V infusion Oral Onset Immediate 1-3 days Duration 3-5 h 2-5 days Mechanism Anti-thrombin-anti-activated factor Xa Interfere with hepatic synthesis of factors II, VII, IX &X antidote Protamine sulfate Vitamin K and fresh frozen plasma Lab control aPTT Prothrombin time-INR Crossing placental No (safe in pregnancy) Yes (unsafe) V. D iscussion Signs of warfarin potassium overdose and toxicity • Any unusual bleeding • Blood in stool or urine • Excessive menstrual bleeding • Bruising • Excessive nose bleeding • Excessive gum bleeding • Persistent oozing from superficial injuries • Bleeding from the tumor, ulcer, or any other lesions • Infrequent reactions as skin necrosis, purple toe syndrome, alopecia, urticaria, dermatitis, fever, anorexia, nausea, diarrhea, abdominal cramps, congenital disabilities, and abortion. Warfarin potassium can be used alone and is appropriate to treat myocardial infarction, but it is associated with the risk of bleeding. The importance of thrombosis in the pathogenesis of heart diseases is well established; the process includes both coagulation system and platelet conditions. Patients with myocardial infarction who survive have a risk of death by 15% to 20% or having a rebound within 2 to 5 years, a proof that substantiates the rationale of secondary antithrombotic prophylaxis. The anticoagulant warfarin potassium has two enantiomers metabolized by liver microsomal enzymes CYP450; R-warfarin potassium is metabolized primarily by CYP1A2 to 6-hydroxy warfarin potassium and 8- hydroxy warfarin potassium. R-warfarin potassium isomer is also metabolized by CYP3A4 to 10-hydroxy warfarin. S-warfarin potassium is metabolized mainly by CYP2C9 to 7-hydroxy warfarin potassium. The efficiency of warfarin potassium is affected particularly when the metabolism of the S-warfarin potassium enantiomer is altered. Warfarin has been studied extensively in many controlled clinical trials. Drug interactions occur due to plasma protein displacement, interactions with the CYP450 enzyme system, or drug metabolism interference. The importance of liver microsomal enzymes genes such as CYP2C9 and VKORC1 genes to the patient-specific dose of warfarin has been established. Warfarin even interacts with natural products like ginseng, as there are documented interactions between alternative therapies and warfarin. Some people who take warfarin use medicinal plants OTC as they consider them a safe medication and do not interact with other prescribed drugs. This issue is very vital; especially with drugs that have a narrow therapeutic index, such as warfarin. Herbal products which may increase the risk of bleeding or even Modulation of Warfarin Sodium into Warfarin Potassium for Patients with Hypertension © 2022 Global Journals 1 Year 2022 12 Global Journal of Science Frontier Research Volume XXII Issue ersion I VII ( G ) Table 1: Comparison between heparin and warfarin potassium showing their effectiveness, route of administration, the onset of action, duration of action, mechanism of action, antidote, lab control, and safety in pregnancy