heparin + enoxaparin + warfarin

Unfractionated heparin + low molecular weight heparin + warfarin is a sequential anticoagulation regimen evaluated in the Cervical Artery Dissection in Stroke Study (CADISS), sponsored by St George's, University of London. The regimen typically begins with initial parenteral anticoagulation using either unfractionated heparin (UFH) or a therapeutic dose of a low-molecular-weight heparin (LMWH), such as enoxaparin, followed by a transition to oral warfarin targeting an international normalized ratio (INR) of 2.0–3.0. This approach is used for the acute treatment of extracranial carotid and vertebral artery dissections to prevent secondary ischemic stroke. Heparins function by binding to and potentiating antithrombin III, which subsequently inactivates thrombin (Factor IIa) and Factor Xa. Warfarin acts as a vitamin K antagonist by inhibiting the enzyme vitamin K epoxide reductase complex subunit 1 (VKORC1), thereby preventing the gamma-carboxylation and activation of vitamin K-dependent clotting factors II, VII, IX, and X. The CADISS trial found no significant difference in the rate of recurrent stroke or death between patients treated with this anticoagulation regimen and those receiving antiplatelet therapy.

Other names

unfractionated heparin + low molecular weight heparin + warfarinUFH + LMWH + warfarinanticoagulation regimen (CADISS)