<unk>  is used for the prophylaxis and treatment of thromboembolic disorders after heart bypass surgery and myocardial infarction (heart attack), long-term treatment of myocardial infarction with increased risk of thromboembolism, thrombophilia (abnormal blood clotting), antithrombin III deficiency, atrial fibrillation (a kind of abnormal heart rhythm) with artery embolisms, after venous thrombosis, pulmonary embolism and artificial heart valve surgery, as well as chronic ventricular aneurysm (bulging of the heart wall) and congestive cardiomyopathy (enlarged heart). Dosing When<unk>  therapy is started, the clotting tendency of the blood is measured daily by determining the prothrombin time, more specifically the international normalized ratio (INR). After the desired INR has been reached, which typically takes five to six days, intervals between measurements are increased to twice or three times a week for a week or two, then to two to four weeks if the patient is stable. INR monitoring continues throughout the therapy, often for life. This is necessary because people need different doses depending on the genetic makeup of their enzymes, activity of coagulation factors, vitamin K concentrations in the body, other drugs, and diet. If a fast onset of action is needed, as after an acute thromboembolism,<unk>  therapy has to be accompanied with a subcutaneous or intravenous low-molecular-weight heparin (LMWH) for the first 36 to 72 hours. Similarly, if the blood thinning effect has to be stopped before a surgery,<unk>  is paused up to two weeks beforehand, and the therapy gap is "bridged" with LMWH until after the surgery. Alternatively,<unk>  can be antagonised with vitamin K, for example before an unplanned surgery, or when severe bleeding occurs after overdosing.
Phenprocoumon
Warfarin
Prasugrel
Elinogrel
Palladin
Dabigatran
Apixaban
Alteplase