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What Should Be Done When On Anticoagulant Acenocoumarin For Mitral Valve Replacement And INR Keeps Fluctuating?

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Posted on Mon, 30 Dec 2013
Twitter Mon, 30 Dec 2013 Answered on
Twitter Tue, 21 Jan 2014 Last reviewed on
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
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Answered by Dr. Hardik Thakker (58 minutes later)
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.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. Hardik Thakker

Internal Medicine Specialist

Practicing since :2006

Answered : 161 Questions

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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.