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Provide a simple and thorough explanation It is a small molecule, it’s lipophilic, it does interfere with vitamin K dependent factors. It inhibits specifically the vitamin K epoxide reductase or, (VKOR). So, VKOR or vitamin K epoxide reductase, may be a term that you see in your exam, and in your exam prep, remember that warfarin inhibits that. Warfarin therefore inhibits vitamins: II, VII, IX, and X. You need to know those factors, these are factors that we’d like to ask questions on. What’s interesting about warfarin, and what’s fun about warfarin is that, it actually inhibits factors C and S as well. So, although it inhibits procoagulant factors, it also inhibits inhibitory factors too. Why is that important? Well, I’ll show you. Take a look at this graph. You can see in blue, that factor C, is one of the first factors that’s inhibited by warfarin. So, inhibition starts with the inhibitory factors protein C and S, this actually gives a procoagulant effect, so, that means that after day one, the other factors are affected, but overall, you have initial period of hypercoagulability, followed by hypocoagulability, this makes for a real headache in the real world. So sometimes, we have patients when we put them on warfarin, actually, form clots more, when we start them on the drug, that’s why in high-risk patients, we bridge them.

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