Acenocoumarol in Thromoembolic Disorders

Thromboembolic disorders are common worldwide, frequently a leading cause of death. Judicial use of Anticoagulant plays an important role in the prevention and treatment of Venous and arterial thromboembolic diseases like deep vein thrombosis, pulmonary embolism, Stroke prevention in valvular and Non-valvular heart disease, and Acute coronary syndrome. Vitamin K antagonists, e.g., acenocoumerol and warfarin are commonly used as oral anticoagulants worldwide. The clinical use of oral anticoagulants has come a long way since their discovery over 50 years ago and Acenocoumarol is a coumarin derivative with pharmacological features closer to an ideal oral anticoagulant. Acenocoumarol is a drug with over 50 years of clinical experience and has been the subject of numerous clinical studies Acenocoumarol is prescribed once every day orally, as the anticoagulant is applied in various thromboembolic disorders. Amongst the coumarone, acenocoumarol is unique, with its rapid onset and offset of action and well documented efficacy and safety. Acenocoumarol has been shown to be superior to warfarin in maintaining INR stability within therapeutic range and efficacy. Despite the development of several new oral anticoagulants, coumarin anticoagulants remained unchallenged. Their efficacy has been established beyond doubt and they have long years of clinical experience. Forever 50 years since its discovery, acenocoumarol still continues to be widely used in India and various parts of the world. risk of thromboembolism is increased by 3–7 times in patients with mitral stenosis in sinus rhythm with atrial fibrillation [3]. Presence of atrial fibrillation without any valve disease may increase the risk of stroke and thromboembolism by five times [3]. Large randomised trials have established the value of antithrombotic treatment for nonvalvular atrial fibrillation. However, anticoagulation remains generally underused in clinical practices [3]. Recent observations have showed that only 56.5% of patients that are taking anticoagulants are at very high risk of stroke in the community and a large proportion of patients affected with atrial fibrillation remained untreated [3]. Coagulation and Antithrombotic Prophylaxis Vitamin K1 is essential for normal blood coagulation. Coagulation factors II, VII, IX and X and the anticoagulant proteins C and S are synthesized mainly in the liver and are biologically inactive unless 9 to 13 of the γ-amino-terminal glutamate residues are carboxylated to form Ca2+binding γ-carboxyglutamate residues. With the carboxylation of the protein precursors, the reduced vitamin cofactor is converted into vitamin K 2,3-epoxide, converted into Vitamin K epoxide reductase, which along with the postulated enzyme vitamin K quinone reductase, are highly sensitive to inhibition by coumarin drugs. Vitamin K1 must be regenerated from the biologically inactive epoxide by vitamin K1 epoxide reductase for the continued synthesis of activated clotting factors, Acenocoumarol and the coumarin anticoagulants are structurally similar to vitamin K and are competitively able to inhibit the enzyme vitamin K-epoxide reductase. These drugs exert *Corresponding author: Dr Abhijit Trailokya, MBBS, Geriatric Medicine, Pharmaceutical Medicine, Chief Manager, Medical Advisor, Medical Services Division, Abbott Healthcare Private Limited, Mulund, Mumbai 400 080, India, Tel: 8080042460; E-mail: [email protected] Received August 26, 2015; Accepted September 22, 2015; Published October 05, 2015 Citation: Trailokya A (2015) Acenocoumarol in Thromoembolic Disorders. Cardiovasc Pharm Open Access 4: 157. doi:10.4172/2329-6607.1000157 Copyright: © 2015 Trailokya A. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. C a r d i o v a sc ul ar Pha ogy: Open A c c e s s