Additionally, because the mechanism involves enzymes such as VKORC1, patients on warfarin with polymorphisms of the enzymes may require adjustments in therapy to account if the genetic variant that they have is more readily inhibited by warfarin, thus requiring lower doses.Warfarin first came into large-scale commercial use in 1948 as a rat poison. Warfarin was formally approved for human use by the U.S. Food and Drug Administration to treat blood clots in 1954. In 1955, warfarins reputation as a safe and acceptable treatment was bolstered when President Dwight D. Eisenhower received warfarin following a massive and highly publicized heart attack. Eisenhowers illness kickstarted a transformation in medicine where coronary artery disease, arterial plaques, and ischemic strokes were treated and prevented by using anticoagulants such as warfarin. It is on the World Health Organizations List of Essential Medicines. Warfarin is available as a generic medication. In 2020, it was the 58th most commonly prescribed medication in the United States, with more than 11 million prescriptions. Medical uses
Warfarin is used to decrease the tendency for thrombosis, or as secondary prophylaxis (prevention of further episodes) in those individuals who have already formed a blood clot (thrombus).
Monoclonal gammopathy, also known as paraproteinemia, is the presence of excessive amounts of myeloma protein or monoclonal gamma globulin in the blood. It is usually due to an underlying immunoproliferative disorder or hematologic neoplasms, especially multiple myeloma. It is sometimes considered equivalent to plasma cell dyscrasia. The most common form of the disease is monoclonal gammopathy of undetermined significance. Causes
Causes of paraproteinemia include the following:
Leukemias and lymphomas of various types, but usually B-cell non-Hodgkin lymphomas with a plasma cell component. Myeloma
Plasmacytoma
Lymphoplasmacytic lymphoma
Idiopathic (no discernible cause): some of these will be revealed as leukemias or lymphomas over the years. AL amyloidosis

Diagnosis
These are characterized by the presence of any abnormal protein that is involved in the immune system, which are most often immunoglobulins and are associated with the clonal proliferation of lymphocytes.When a paraproteinemia is present in the blood, there will be a narrow band, or spike, in the serum protein electrophoresis because there will be an excess of production of one protein.There are two large classes of blood proteins: albumin and globulin. They are generally equal in proportion, but albumin is much smaller than globulin, and slightly negatively charged, which leads to an accumulation at the end of the electrophoretic gel. The globulins separate out into three regions on the electrophoretic gel, which are the α band, the β band, and the γ band. The α band can be separated into two components: α1 and α2. The α1 region consists mostly of α1-antitrypsin and α1-acid glycoprotein. The α2 region is mostly haptoglobin, α2-macroglobulin, α2-antiplasmin, and ceruloplasmin.