Leitura clínica
Comentário
Anticoagulante cumariníco antagonista da vitamina K que se utiliza para o tratamento e profilaxia de transtornos tromboembólicos. Atua deprimindo a síntese hepática de fatores de coagulação dependentes da vitamina K. Administração oral ou intravenosa. Inicialmente foi utilizado como raticida. A Varfarina se detecta no leite materno em quantidade nula ou clinicamente não significativa. (McKenna 1983, Orme 1979 y 1977, De Swiet 1977) Não foram observados problemas em bebês cujas mães a tomavam. (Ito 1993, McKenna 1983) Os níveis em plasma de ditos bebês foram indetectáveis. (Orme 1977) Nem sequer em um caso de sobredose materna acidental o bebê apresentou nenhum problema nem se alteraram as provas de coagulação. (Schindler 2011) Diversas sociedades médicas e autores especialistas consideram seguro o uso desta medicação durante a amamentação. (LactMed, Azenkot 2022, Sucker 2020, Bates 2018, 2012 y 1997, Schaefer 2015, Marshall 2014, Rowe 2013, Fuller 2013, Yurdakök 2012, Middeldorp 2011, Amir 2011, Dresang 2008, Clark 2000, Greer 1998, Letsky 1997, Leys 1997, Hirsh 1995, Olthof 1993, Ginsberg 1988) Lista de medicamentos essenciais OMS: compatível com a amamentação (WHO-UNICEF 2002). Academia Americana de Pediatria: medicação geralmente compatível com a amamentação. (AAP 2001)
Encontrabilidade
Outros nomes e marcas
Sinônimos e grafias 9
- Cumafeno
- Warfarina potasica. Warfarina sódica
- βαρφαρίνη
- وارفارين
- Варфарин
- 华法林
- ワルファリン
- 워파린
- B01AA03
Marcas comerciais na fonte 31
- Agrorat War
- Aldocumar
- Anasmol
- Befarin
- Circuvit
- Co-Rax
- Cogulax
- Coumadin
- Coumadine
- Cov-R-Tox
- Cumar
- Fargem
- Jantoven
- Marevan
- Marevan (Мареван)
- Marevan (华法林)
- Marfarin
- Orfarin
- Panwarfin
- Raticida Ibys
- Ratozan
- Rax
- Rodex
- Romesa
- Tedicumar
- Tox-Hid
- Varfine
- Warfarex (Варфарекс)
- Warfilone
- Zoocumarina
- d-Con
Dados da fonte
Farmacocinética
| Variável | Valor | Unidade |
|---|---|---|
| Biodisp. oral | 100 | % |
| Peso Molecular | 308 | daltons |
| Unión proteínas | 99 | % |
| Vd | 0,14 | l/Kg |
| pKa | 5,56 | - |
| Tmax | 4 (1 - 9) | horas |
| T½ | 40 (21 - 60) | horas |
| Índice L/P | 0,2 | - |
| Dosis Teórica | <0,0001 | mg/Kg/d |
| Dosis Relativa | 0,01 | % |
| Dosis Rel. Ped. | 0,003 | % |
Rastreabilidade
Bibliografia
- Azenkot T, Schwarz EB. Special Considerations for Women of Reproductive Age on Anticoagulation. J Gen Intern Med. 2022 Aug;37(11):2803-2810. Resumen Texto completo (enlace a fuente original)
- Sucker C. Prophylaxis and Therapy of Venous Thrombotic Events (VTE) in Pregnancy and the Postpartum Period. Geburtshilfe Frauenheilkd. 2020 Jan;80(1):48-59. Resumen Texto completo (enlace a fuente original)
- Bates SM, Rajasekhar A, Middeldorp S, McLintock C, Rodger MA, James AH, Vazquez SR, Greer IA, Riva JJ, Bhatt M, Schwab N, Barrett D, LaHaye A, Rochwerg B. American Society of Hematology 2018 guidelines for management of venous thromboembolism: venous thromboembolism in the context of pregnancy. Blood Adv. 2018 Nov 27;2(22):3317-3359. Resumen Texto completo (enlace a fuente original)
- Marshall AL. Diagnosis, treatment, and prevention of venous thromboembolism in pregnancy. Postgrad Med. 2014 Resumen
- Fuller KP, Turner G, Polavarapu S, Prabulos AM. Guidelines for use of anticoagulation in pregnancy. Clin Lab Med. 2013 Resumen
- Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. Resumen
- Bates SM, Greer IA, Middeldorp S, Veenstra DL, Prabulos AM, Vandvik PO; American College of Chest Physicians. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):e691S-e736S. Resumen Texto completo (enlace a fuente original) Texto completo (en nuestros servidores)
- Yurdakök M. Fetal and neonatal effects of anticoagulants used in pregnancy: a review. Turk J Pediatr. 2012 Resumen
- Schindler D, Graham TP. Warfarin Overdose in a Breast-feeding Woman. West J Emerg Med. 2011 Resumen Texto completo (enlace a fuente original)
- Middeldorp S. How I treat pregnancy-related venous thromboembolism. Blood. 2011 Resumen Texto completo (enlace a fuente original) Texto completo (en nuestros servidores)
- Amir LH, Pirotta MV, Raval M. Breastfeeding--evidence based guidelines for the use of medicines. Aust Fam Physician. 2011 Sep;40(9):684-90. Review. Resumen
- Dresang LT, Fontaine P, Leeman L, King VJ. Venous thromboembolism during pregnancy. Am Fam Physician. 2008 Resumen
- WHO / UNICEF. BREASTFEEDING AND MATERNAL MEDICATION Recommendations for Drugs in the Eleventh WHO Model List of Essential Drugs. Department of Child and Adolescent Health and Development (WHO/UNICEF) 2002 Resumen Texto completo (enlace a fuente original) Texto completo (en nuestros servidores)
- AAP - American Academy of Pediatrics Committee on Drugs. Transfer of drugs and other chemicals into human milk. Pediatrics. 2001 Sep;108(3):776-89. Resumen Texto completo (enlace a fuente original) Texto completo (en nuestros servidores)
- Clark SL, Porter TF, West FG. Coumarin derivatives and breast-feeding. Obstet Gynecol. 2000 Resumen
- Greer IA. The special case of venous thromboembolism in pregnancy. Haemostasis. 1998 Resumen
- Bates SM, Ginsberg JS. Anticoagulants in pregnancy: fetal effects. Baillieres Clin Obstet Gynaecol. 1997 Resumen
- Leys D, Lamy C, Lucas C, Hénon H, Pruvo JP, Codaccioni X, Mas JL. Arterial ischemic strokes associated with pregnancy and puerperium. Acta Neurol Belg. 1997 Resumen
- Letsky EA. Peripartum prophylaxis of thrombo-embolism. Baillieres Clin Obstet Gynaecol. 1997 Resumen
- Hirsh J. Optimal intensity and monitoring warfarin. Am J Cardiol. 1995 Resumen
- Olthof E, de Vries TW. [Breast feeding and oral anticoagulants]. Tijdschr Kindergeneeskd. 1993 Resumen
- Ito S, Blajchman A, Stephenson M, Eliopoulos C, Koren G. Prospective follow-up of adverse reactions in breast-fed infants exposed to maternal medication. Am J Obstet Gynecol. 1993 May;168(5):1393-9. Resumen
- Ginsberg JS, Hirsh J. Optimum use of anticoagulants in pregnancy. Drugs. 1988 Resumen
- McKenna R, Cole ER, Vasan U. Is warfarin sodium contraindicated in the lactating mother? J Pediatr. 1983 Resumen
- Orme ML, Serlin MJ, Breckenridge A. Thromboembolism in pregnancy. Br Med J. 1979 Resumen Texto completo (enlace a fuente original)
- De Swiet M, Lewis PJ. Excretion of anticoagulants in human milk. N Engl J Med. 1977 Resumen
- Orme ML, Lewis PJ, de Swiet M, Serlin MJ, Sibeon R, Baty JD, Breckenridge AM. May mothers given warfarin breast-feed their infants? Br Med J. 1977 Resumen Texto completo (enlace a fuente original)