Level of which clotting factor falls first after giving warfarin?
**Core Concept:** Warfarin is an anticoagulant drug that inhibits vitamin K-dependent clotting factors, primarily factor II (thrombin), factor VII, factor IX, and factor X. These clotting factors are involved in the intrinsic and extrinsic pathways of coagulation. Warfarin's action results in increased bleeding risk.
**Why the Correct Answer is Right:** Warfarin inhibits the synthesis of vitamin K-dependent clotting factors II, VII, IX, and X, leading to a decrease in their levels in the blood. This results in a prolongation of the prothrombin time (PT) and activated partial thromboplastin time (aPTT) assays, indicating impaired clotting.
**Why Each Wrong Option is Incorrect:**
A. Factor II (thrombin) is not the first clotting factor to fall in response to warfarin.
B. Factor VIII is not a vitamin K-dependent clotting factor and is not affected by warfarin.
C. Factor XI is not a vitamin K-dependent clotting factor and is not affected by warfarin.
D. Factor XII is not a vitamin K-dependent clotting factor and is not affected by warfarin.
**Clinical Pearl:** The monitoring of anticoagulation therapy with warfarin is done by measuring PT and aPTT, which should ideally be in the therapeutic range (INR 2.0-3.0) to prevent thrombosis while minimizing bleeding risk.
**Correct Answer:** D. Factor XII (Hageman factor) is the first clotting factor to fall in response to warfarin. This is because it is a vitamin K-dependent clotting factor involved in the intrinsic pathway of coagulation, which is affected by warfarin.