Blood Clotting Affected By Warfarin

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Blood Clotting Affected By Warfarin

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Discuss about the Blood clotting affected by warfarin.

Answer:

Introduction
The clotting system involves a process where blood forms clots following a tissue injury to prevent further blood loss(Gee, 2018). The process follows a coagulation cascade where various clotting factors are involved(Gee, 2018). There are two major pathways of the coagulation which include the intrinsic and extrinsic pathways. There are several coagulation factors that are involved in both pathways which include the tissue factor, factors XIII, XII, XI, X, IX, VIII, VII, V, IV, III, II and I(Tshikudi, Tripathi, Hajjarian, Van Cott & Nadkarni, 2017). Other important factors include calcium ions and vitamin K(Gee, 2018). Vitamin K is involved in activation of various coagulation factors. Warfarin work against as vitamin K hence it can inhibit the whole process resulting in homeostasis imbalance(Tshikudi, Tripathi, Hajjarian, Van Cott & Nadkarni, 2017).
Blood clotting affected by warfarin
The blood clotting cascade is influenced by various clotting factors and cofactors. The cofactors are usually the inactive form of certain factors that activates various clotting factors into active forms(Palta, Saroa & Palta, 2014). Failure of this activation, no blood clotting can occur(Gee, 2018). Vitamin K is one of the cofactors used to activate the clotting factors X, IX, VII and II. An increased activation of vitamin K will lead to increase in clotting process and vise vasa(Gee, 2018).

Therefore, VItamin K acts as an important contributing factor of the clotting process due to its effects on its dependent factors of the coagulation cascade(Goodman, Brunton, Chabner & Knollmann, 2012). This is due to the fact that, Vitamin K form one of the major factor that is required by the liver microsomal enzyme known as vitamin K epoxide reductase (VKOR) that catalyzes the conversion of the specific glutamyl precursors of the vitamin K clotting factors to gamma-carboxyl glutamyl residues in a plasma form of these proteins(Goodman, Brunton, Chabner & Knollmann, 2012). The product that comes from this carboxylation reaction is the 2, 3 eporoxide of Vitamin K quinone. Warfarin, which acts as the Vitamin K inhibitor is made up of the mixture of S- and R- enantiomers(Palta, Saroa & Palta, 2014).
The S- warfarin is usually the most active type of enantiomer than the R-warfarin. Both warfarin enantiomers inhibit the process of coagulation by blocking the enzymes encoded as VKORC1(Malátková, Sokolová, Chocholoušová Havlíková & Wsól, 2016). This, in turn, read to the reduction of peroxides of the vitamin K or oxidized vitamin K into an active coenzyme of the vitamin known as hydroquinone(Goodman, Brunton, Chabner & Knollmann, 2012). Since vitamin K serves a major cofactor of glutamyl carboxylase that serves as the catalyst in the carboxylation process of factors X, IX, VII and II, this characteristic of Warfarin decreases the activity of all carboxylated clotting factors that are dependent on vitamin K(Harter, Levine & Henderson, 2015).
Calcium ions that usually activate prothrombin to thrombin normally function well in the presence of gamma carboxyl glutamyl in order to form des-gamma-carboxyl forms of prothrombin. Thereby, only the activated vitamin K can act as a cofactor in the conversion of prozymogens into zymogens capable of binding with calcium ions and smoothly interacting with phospholipids surfaces(Goodman, Brunton, Chabner & Knollmann, 2012). Therefore, the introduction of warfarin normally reduces the blood thrombotic potential as the needed factors are inactivated. The reduced vitamin K can be held back into normal through the intake of more vitamins K in the body and reduced dose of warfarin(Malátková, Sokolová, Chocholoušová Havlíková & Wsól, 2016). Below is the concept map that summarises the above whole process.
Summary Concept map
A summary concept map usually presents a relationship between various items and facts inform ofa diagram in order to show certain concepts of knowledge.
A concept map is meant to demonstrate an overall picture of a given topic by showing how various interacting subunits work to bring an overall outcome.
The diagram below demonstrate how warfarin affect the vitamin K dependant factors of coagulation process therefore ending up affecting the clotting process.

Concept Map and the disease

The impact of the disease process could be presented clearly be demonstrated on this concept map by introducing a personwith a fresh tissue injury for example.
After tissue injury, the body respondsto the clotting process to prevent further bleeding.
The clotting process involvesboth intrinsic and extrinsic pathways where various clotting factors are involved to enhance coagulation process.
Oxidized Vitamin K is involvedinactivation of clotting factors X, IX, VII and II, and proteins C and S of which play a key role in the clotting process.
The factors involved can be well be demonstrated by putting them in bold colorin order to show the exact stages of clotting process affected
Warfarin normally reducesoxidized vitamin K into its inactive form hence the clotting factors will not be activated. This, in turn, leads to more bleeding as the normal homeostasis is affected.

References
Gee, E. (2018). Principles and nursing management of anticoagulation. Nursing
Standard, 32(23), 50-63.
Goodman, L., Brunton, L., Chabner, B., & Knollmann, B. (2012). Goodman & Gilman’s
pharmacological basis of therapeutics. New York: McGraw-Hill.
Harter, K., Levine, M., & Henderson, S. (2015). Anticoagulation Drug Therapy: A
Review. Western Journal Of Emergency Medicine, 16(1), 11-17.
Malátková, P., Sokolová, S., Chocholoušová Havlíková, L., & Wsól, V. (2016). Carbonyl
reduction of warfarin: Identification and characterization of human warfarin reductases. Biochemical Pharmacology, 109, 83-90.
Palta, S., Saroa, R., & Palta, A. (2014). Overview of the coagulation system. Indian Journal Of
Anaesthesia, 58(5), 515.
Tshikudi, D., Tripathi, M., Hajjarian, Z., Van Cott, E., & Nadkarni, S. (2017). Optical sensing of
anticoagulation status: Towards point-of-care coagulation testing. PLOS ONE, 12(8),

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