What Should Be Done When On Anticoagulant Acenocoumarin For Mitral Valve Replacement And INR Keeps Fluctuating?
Posted on Tue, 21 Jan 2014
88184
Question: I have had MVR about 20yrs ago and have maintained INR AT 2.5 TO 3.0, with Acitrom 1mg and 2mg alternate day
since a month the INR IS fluctuating and goes to 5.5 and if I miss about 3mg it goes to 1.5 or so
Diet has been the same Pl advise
Brief Answer:
brand/compliance/ interaction/ genetic polymorphis
Detailed Answer:
Dear patient.
Greetings from health care magic!!! I am Dr Thakker and shall be answering your question.
You are on anticoagulant acenocoumarin for the mitral valve replacement. since your INR has been fluctuating of late we would consider the following:
1) Have you changed the brand of medicine? The bioavailability of different brands differs slightly. I would suggest you stick to same brand as before.
2) Have you been compliant? I would suggest you take the medicine at 7 pm every day so that you don't miss out on the dose.
3) Have you consumed a lot of green leafy vegetables this month? They contain a plant form of vitamin k which will interfere with action of acenocoumain.
4) Have you taken any other medicine like phenytoin/ rifampicin/ cimetidine? these affect the enzymes which metabolize the drug acenocoumatin in your body and affect the INR.
5) Genetic polymorphism: I would recommend you to perform CYP2c9 and VKOR isoenzyme study. You may be having an enzyme isoform which metabolizes acenocoumarin slowly.
I hope this helps you out. Please reply to the above questions. If you have any more questions, please do not hesitate to write back to me.
Yours sincerely,
Dr Thakker.
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What Should Be Done When On Anticoagulant Acenocoumarin For Mitral Valve Replacement And INR Keeps Fluctuating?
Brief Answer:
brand/compliance/ interaction/ genetic polymorphis
Detailed Answer:
Dear patient.
Greetings from health care magic!!! I am Dr Thakker and shall be answering your question.
You are on anticoagulant acenocoumarin for the mitral valve replacement. since your INR has been fluctuating of late we would consider the following:
1) Have you changed the brand of medicine? The bioavailability of different brands differs slightly. I would suggest you stick to same brand as before.
2) Have you been compliant? I would suggest you take the medicine at 7 pm every day so that you don't miss out on the dose.
3) Have you consumed a lot of green leafy vegetables this month? They contain a plant form of vitamin k which will interfere with action of acenocoumain.
4) Have you taken any other medicine like phenytoin/ rifampicin/ cimetidine? these affect the enzymes which metabolize the drug acenocoumatin in your body and affect the INR.
5) Genetic polymorphism: I would recommend you to perform CYP2c9 and VKOR isoenzyme study. You may be having an enzyme isoform which metabolizes acenocoumarin slowly.
I hope this helps you out. Please reply to the above questions. If you have any more questions, please do not hesitate to write back to me.
Yours sincerely,
Dr Thakker.