As the bodys stores of previously produced active factors degrade (over several days) and are replaced by inactive factors, the anticoagulation effect becomes apparent. The coagulation factors are produced, but have decreased functionality due to undercarboxylation; they are collectively referred to as PIVKAs (proteins induced [by] vitamin K absence), and individual coagulation factors as PIVKA-number (e.g., PIVKA-II). When warfarin is newly started, it may promote clot formation temporarily, because the level of proteins C and S are also dependent on vitamin K activity. Warfarin causes decline in protein C levels in first 36 hours. In addition, reduced levels of protein S lead to a reduction in activity of protein C (for which it is the co-factor), so reduces degradation of factor Va and factor VIIIa. Although loading doses of warfarin over 5 mg also produce a precipitous decline in factor VII, resulting in an initial prolongation of the INR, full antithrombotic effect does not take place until significant reduction in factor II occurs days later. The haemostasis system becomes temporarily biased towards thrombus formation, leading to a prothrombotic state. Thus, when warfarin is loaded rapidly at greater than 5 mg per day, to co-administering heparin, an anticoagulant that acts upon antithrombin and helps reduce the risk of thrombosis, is beneficial, with warfarin therapy for four to five days, to have the benefit of anticoagulation from heparin until the full effect of warfarin has been achieved. Pharmacogenomics
Warfarin activity is determined partially by genetic factors.
Accessory breasts, also known as polymastia, supernumerary breasts, or mammae erraticae, is the condition of having an additional breast. Extra breasts may appear with or without nipples or areolae. It is a condition and a form of atavism which is most prevalent in male humans, and often goes untreated as it is mostly harmless. In recent years, many affected women have had a plastic surgery operation to remove the additional breasts, for purely aesthetic reasons. A related condition, in which extra nipples form, is called "supernumerary nipple" or "polythelia". Presentation
In some cases, the accessory breast may not be visible at the surface. In these cases, it may be possible to distinguish their appearance from normal breast tissue with MRI. In other cases, accessory breasts have been known to lactate, as illustrated in a drawing showing a child nursing at ectopic breast tissue on the lateral thigh. There is some evidence that the condition may be more common in Native American populations. Cause
Polymastia typically occurs in the womb during the development. During normal development, breast tissue will develop along the milk line, and additional tissue will disintegrate and be absorbed into the body. Polymastia occurs when the additional tissue does not disintegrate before birth. This condition can be inherited. See also
Artemis § As the Lady of Ephesus (fertility goddess with many breasts)
Fleischers syndrome

References

A Paper on the Appearance of Multiple Mammaries in Humans, R. Eghardt, Oxford University Press (1923)
Weird Diseases, B. Hargreaves and M. Wallette, Emu Publishing (2007)


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