Azenmarol 1 Agimexpharm treat myocardial infarction, heart disease (10 blisters x 10 tablets)

acenocoumarol is a vitamin K-resistant cooumarin conductor.

As such, vitamin K -resistant coumarin derivatives have an indirect anticoagulant effect by preventing the synthesis of the activity of the above coagulation factors (II, VII, IX, X).

After taking acenocoumarol, the effect on prolongrombin time is usually maximum within 24 to 48 hours, depending on the dose. After stopping the drug 48 hours, the prothrombin time is back before taking the drug.

After drinking, generally, vitamin K -resistant coumarin derivatives lower blood prothrombin within 36 to 72 hours. Balancing treatment with vitamin K anti -vitamin K medication requires many days. After stopping the drug, anticoagulants can last for 2-3 days. The drug can limit the development of the existing thrombosis and prevent secondary symptoms of thrombosis, although there is no direct thrombotic effect because it does not reverse the damage of ischemic tissue.

Compared to wafarin and phenprocoumon, acenocoumarol has the advantage of shorter effect time.

Dynamic pharmacokinetics

acenocoumarol is quickly absorbed through the gastrointestinal tract. Oral bioavailability reaches 60%. A significant part of isomorphic s (-)-acenocoumarol through initial metabolism in the liver, while the bioavailability of isomers R (+)-Acenocoumarol is 100%. The drug is strongly attached to plasma proteins (99%). The peak concentration of the drug in plasma is within 1-3 hours. Distribution volume 0.16 - 0.34 liters/kg. Acenocoumarol through the placenta and a small part is detected in breast milk.

Acenocoumarol is metabolized in the liver by the cytochrom P450 enzyme system (isenzyme CYP2C9 isomered S isomer, r isomer is metabolized by some other isenzymes) into non -active amino and acetamid metabolites. Some other metabolites such as diastereoisometric alcohol and hydroxyl metabolites may be active. Clinicians need to know the possibility of some highly sensitive patients with acenocoumarol due to the polymorphism of the liver, and may have to reduce the dose in that patient.

Half lifetime elimination of acenocomarol is about 8 -11 hours.

The drug is excreted mainly in urine (60% in about 1 week) in the form of metabolism and partly through feces (29% in about 1 week).

INR is a way to indicate the time to the sensitivity of the reagent (thromboplastin) used for testing, so it should reduce erratic changes between labo.

When not taking anti -vitamin K, Inr in normal people is 1. When taking the drug in the following situations, in most cases the target of the INR needs to be 2.5, fluctuating in the range of 2 and 3. Inr below 2 reflects the use of anticoagulants is not enough. Inr above 3 is to use excess medicine. Inr above 5 is at risk of bleeding.

When not taking anti -vitamin K, Inr in normal people is 1. When taking the drug in the following situations, in most cases the target of the INR needs to be 2.5, fluctuating in the range of 2 and 3. Inr below 2 reflects the use of anticoagulants is not enough. Inr above 3 is to use excess medicine. Inr above 5 is at risk of bleeding.

Perform biological pace:

The first test was conducted 48 hours ± 12 hours after taking the first vitamin K anti -vitamin to detect an increase in individual sensitivity. If INR above 2, signaling will overdose when balanced, so the dose should be reduced. The following tests are conducted daily or Japan until the INR is stable, then gradually away from the response, the longest is every 12 weeks.

Balance of treatment sometimes only reaches after weeks. After each dose change, check the Inr 1-2 days later and repeat until stable.

In general, Inr from 2-3 is recommended to prevent venous thrombosis, including pulmonary embolism, atrial fibrillation, heart valve, or biological valve. Inr from 2.5 to 3.5 is recommended after myocardial infarction, people with mechanical valve disease, or in some patients with thrombosis or phospholipid syndrome. Higher Inr can be recommended for recurrent clogged.

Dosage in the elderly:

Due to the slow anticoagulant effects of vitamin K anti -vitamin drugs, heparin must be maintained with constant doses during the necessary time, that is, until the INR is in the desired value for 2 consecutive days.

In case of heparin platelets, vitamin K should not be given soon after stopping heparin because of the risk of increased blood clotting due to protein S (anticoagulant) is reduced early. Only vitamin K resistance after giving thrombin drugs (Danaparoid or Hirudine).

Need to stop anticoagulants 5 days before surgery. If the day before the Inr ≥ 1.5 surgery, the vitamin K should be given injected with 1 - 5mg injected form. If the bleeding is good, it is possible to reuse the drug (acenocoumarol) with a normal maintenance dose on the surgical day or the next morning.

Patients stop the drug before surgery is considered to be high risk, so it may need support with a low molecular heparin (used for treatment). Need to stop the molecular heparin at least 24 hours before surgery. If surgery is at high risk of bleeding, do not reuse low molecular heparin within at least 48 hours after surgery.

Patients taking drugs (acenocoumarol) need urgent surgery that may slow down about 6 - 12 hours, it can be given intravenous 5 mg of vitamin K to reverse anticoagulant effect. If it is not possible to postpone, both vitamin K and dry prothrombin mixture (for example, 25 units/kg) and must be tested for Inr before surgery.

What to do when overdose?

Symptoms:

The outstanding manifestation of the overdose is bleeding, which can occur within 1-5 days after taking the drug. Hemorrhage manifestations can be noticed: nose bleeding, vomiting blood, coughing up blood, stomach bleeding, vaginal bleeding, hematuria (with kidney cramps), bleeding under the skin, gum bleeding, hematoma, and bleeding in joints or menorrhagia.

Can see symptoms of tachycardia, hypotension, peripheral circulatory disorders due to blood loss, nausea, vomiting, diarrhea and abdominal pain.

Management:

Handling when patients with overdose symptoms are often based on Inr and signs of bleeding, adjustment measures must be sequentially so as not to risk thrombosis. If you have used anticoagulants but do not use vitamin K, need to re -test Inr 2-3 days later to make sure the INR has dropped.

If Inr

In case of poisoning due to an accident, it must also be evaluated according to INR and manifests bleeding complications. Must measure the Inr many days later (2-5 days), taking into account for half a long life of anticoagulant drugs. Use vitamin K to adjust the effects of anticoagulant drugs.

In an emergency, call the 115 emergency center immediately or go to the nearest local health station.

What to do when you forget 1 dose? However, if the time to relax with the next dose is too short, skip the dose and continue the calendar of the drug. Do not use double dose to compensate for missed dose.

Be cautious when using

Do not coordinate: