The Intern At Work: Internal Medicine cover image

The Intern At Work: Internal Medicine

107. Sorting out a bloody mess: an overview of anticoagulation

Sep 19, 2021
Dr. Janet Lui, a hematologist, and Dr. Marie Leung, a general internist, discuss various anticoagulants beyond warfarin. They explore the history of anticoagulation, mechanisms of clot formation, comparison of different anticoagulants, monitoring methods, bleeding management, and reversal agents.
15:59

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Quick takeaways

  • Warfarin, a derivative of dichromal, initially developed as rat poison, gained acceptance for human use after President Eisenhower's successful treatment.
  • Anticoagulants, including heparins, warfarins, and DOACs, work by different mechanisms like inhibiting thrombin, factor 10a, or clotting factors, offering various options for treatment.

Deep dives

The History of Warfarin and its Evolution as an Anticoagulant

American dairy farmers in the 1920s noted cows bleeding due to moldy sweet clover hay, leading to the identification of the compound dichromal that inhibits clotting. Warfarin, a potent variant of dichromal, was originally developed as a rat poison but later found safe in humans under the name coumadin. Despite initial reluctance due to its rat poison association, Warfarin gained popularity after President Eisenhower's successful treatment with it. Today, Warfarin remains widely used globally, along with newer anticoagulants.

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