Inappropriate use of the drug acenocoumarol in non-valvular atrial fibrillation
Abstract
Introduction: The use of acenocoumarol as an anticoagulant represents a contribution to the treatment of non-valvular atrial fibrillation. At present, there are other types of anticoagulants that do not require such exhaustive control of the International Normalized Ratio digital test and have fewer side effects. Spain is one of the few countries in Europe that continues to prescribe acenocoumarol, which is similar to warfarin. So much so that primary care physicians are not allowed to prescribe other more effective and less troublesome anticoagulants for the patient when performing the digital test.
Objective: To analyze the inappropriate use of the drug acenocoumarol in non-valvular atrial fibrillation.
Methods: An exploratory study was carried out in a primary health care system and secondary category hospitals. The population consisted of 2650 inhabitants of southeastern Spain with non-valvular atrial fibrillation, taking acenocoumarol with 12 months follow-up.
Results: We considered the variations and lability of the International Normalized Ratio value, between 2.0-3.0 in determinations every 28 days, regardless of cardiovascular disease and figures obtained in relation to the previous. The follow-up time was 12 months and the lability disappeared, samples were taken every 28 days. Before the end of the study, the lability of the International Normalized Ratio disappeared for more than three months in 53 (97.95%) of the patients. Since most of the patients taking acenocoumarol were over 65 years of age and on polymedication, the medications taken by each of them were evaluated.
Conclusions: The time elapsed between the International Normalized Ratio determination and the last intake of food and medication was not correct, and there is a tendency to perform anarchic determinations of the International Normalized Ratio without investigations related to drugs consumed together with acenocoumarol.
DeCS: ACENOCOUMAROL/therapeutic use; ANTICOAGULANTS; ATRIAL FIBRILLATION/ drug therapy; INTERNATIONAL NORMALIZED RATIO; MEDICATION THERAPY MANAGEMENT.
Downloads
References
1. Breijo-Márquez FR. Misuse of the Drug Acenocoumarol in a Population of 250 Inhabitants with Non-valvular Atrial Fibrillation Assessed in a Region of Southeaster of Spain. Acta Scientific Medical Sciences [Internet]. 2022 [citado 14 Ago 2023];6(12):44-48. Disponible en: https://www.actascientific.com/ASMS/ASMS-06-1401.php
2. Evrard J, Siriez R, Bouvy C, Favresse J, Yildiz H, Hainaut P, et al. Comparison of analytical performances between clot waveform analysis and FibWave in edoxaban-treated patients and healthy controls. Res Pract Thromb Haemost [Internet]. 2022 Oct [citado 14 Ago 2023];6(7): e12804. Disponible en: https://www.sciencedirect.com/science/article/pii/S2475037922024438
3. Kearon C, Akl EA, Ornelas J, Blaivas A, Jimenez D, Bounameaux H, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest [Internet]. 2016 Feb [citado 14 Ago 2023];149(2):315-52. Disponible en: https://journal.chestnet.org/article/S0012-3692(15)00335-9/fulltext
4. Steffel J, Collins R, Antz M, Cornu P, Desteghe L, Haeusler KG, et al. 2021 European Heart Rhythm Association Practical Guide on the Use of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation. Europace [Internet]. 2021 Oct [citado 14 Ago 2023];23(10):1612-76. Disponible en: https://academic.oup.com/europace/article/23/10/1612/6247378?login=false
5. Douxfils J, Ageno W, Samama CM, Lessire S, Ten Cate H, Verhamme P, et al. Laboratory testing in patients treated with direct oral anticoagulants: a practical guide for clinicians. J Thromb Haemost [Internet]. 2018 Feb [citado 14 Ago 2023];16(2):209-19. Disponible en: https://onlinelibrary.wiley.com/doi/full/10.1111/jth.13912
6. Galindo Suárez RM, Martínez Valdes E, Frati Munari AC. Análisis de costo-efectividad de los inhibidores de la bomba de protones en el tratamiento de la enfermedad por reflujo gastroesofágico. Med Int Mex [Internet]. 2005 Sep-Oct [citado 14 Ago 2023];21(5):347-54. Disponible en: https://www.medigraphic.com/pdfs/medintmex/mim-2005/mim055d.pdf
7. Douxfils J, Chatelain C, Chatelain B, Dogné JM, Mullier F. Impact of apixaban on routine and specific coagulation assays: a practical laboratory guide. Thromb Haemost. 2013 Aug;110(2):283-94. doi:10.1160/TH12-12-0898.
8. Dalmau Llorca MR, Aguilar Martín K, Carrasco-Querol N, Hernández Rojas Z, Forcadell Drago E, Rodríguez Cumplido D, et al. Adecuación de anticoagulantes orales en fibrilación auricular no valvular en Atención Primaria: A Cross-Sectional Study Using Real-World Data (Estudio Fantas-TIC). Int J Environ Res Public Health [Internet]. 2021 [citado 14 Ago 2023];18(5):2244. Disponible en: https://www.mdpi.com/1660-4601/18/5/2244
9. Mulet Batista DH, Ramírez Pérez C, Abreu Sera G, Pérez Mir J, Pérez González J. Coeficiente internacional normalizado, útil herramienta en la terapia anticoagulante oral. Medisur [Internet]. 2012 May-Jun [citado 14 Ago 2023];10(3). Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1727-897X2012000300002
10. Fernández MÁ. La administración de dos dosis diarias de acenocumarol mejora la estabilidad del INR en pacientes con prótesis valvulares mecánicas. Haematologica. 2004;89(Supl 2):171.
11. Ray WA, Chung CP, Murray KT, Smalley WE, Daugherty JR, Dupont WD, et al. Association of Proton Pump Inhibitors With Reduced Risk of Warfarin-Related Serious Upper Gastrointestinal Bleeding. Gastroenterology [Internet]. 2016 Dic [citado 14 Ago 2023];151(6):1105-12. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5124401/
12. Teichert M, van Noord C, Uitterlinden AG, Hofman A, Buhre PN, De Smet PA, et al. Proton pump inhibitors and the risk of overanticoagulation during acenocoumarol maintenance treatment. Br J Haematol [Internet]. 2011 May [citado 14 Ago 2023];153(3):379-85. Disponible en: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2141.2011.08633.x?sid=nlm%3Apubmed
13. Lozano R. Drug-drug interactions between acenocoumarol and proton pump inhibitors in hospitalized patients: Overanticoagulation associated with intravenous omeprazole. Int J Clin Pharmacol Ther [internet]. 2021 Oct [citado 14 Ago 2023];59(10):671-3. Disponible en: https://www.dustri.com/nc/article-response-page.html?artId=188610&doi
14. Uno T, Sugimoto K, Sugawara K, Tateishi T. The role of cytochrome P2C19 in R-warfarin pharmacokinetics and its interaction with omeprazole. Ther Drug Monit [Internet]. 2008 Jun [citado 14 Ago 2023];30(3):276-81. Disponible en: https://journals.lww.com/drug-monitoring/abstract/2008/06000/the_role_of_cytochrome_p2c19_in_r_warfarin.3.aspx
15. Calderon-Ospina CA, Dominguez-Dominguez CA. Sobre-anticoagulación por warfarina ocasionada por múltiples errores de medicación. Pharm Care Esp [Internet]. 2018 [citado 14 Ago 2023];20(6):478-84. Disponible en: https://www.pharmcareesp.com/index.php/PharmaCARE/article/view/474/389
16. López de Luca B, Murgadella Sancho A, Padulles Zamora A, Serrano Arjona O, Roca Massa M, March Pujol M. Acenocumarol. Estudio de sus interacciones en pacientes hospitalizados. Offarm: farmacia y sociedad [Internet]. 2006 May [citado 14 Ago 2023];25(3):90-5. Disponible en: https://www.elsevier.es/es-revista-offarm-4-articulo-acenocumarol-13088619
17. García Tenés B, García Cebrián F. A propósito de acenocumarol y sus interacciones. Pharm Care Esp [Internet]. 2011 [citado 14 Ago 2023];13(2):91-93. Disponible en: https://www.pharmcareesp.com/index.php/PharmaCARE/article/view/22/21
18. Rubio Armendáriz C, Alberto Armas D, Plasín Rodríguez Montserrat G, Padrón Fuentes
CC, Casanova Herrera NR, González González MY. Acenocumarol: uso, adherencia y conocimiento del usuario. Oportunidades para la Atención Farmacéutica. JONNPR [Internet]. 2021 Dic [citado 22 Sep 2023];6(12):1427-45. Disponible en: https://scielo.isciii.es/pdf/jonnpr/v6n12/2529-850X-jonnpr-6-12-1427.pdf
19. Teichert M, van Noord C, Uitterlinden AG, Hofman A, Buhre PN, De Smet PA, et al. Proton pump inhibitors and the risk of overanticoagulation during acenocoumarol maintenance treatment. Br J Haematol [Internet]. 2011 May [citado 16 Ago 2023];153(3):379-85. Disponible en: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2141.2011.08633.x?sid=nlm%3Apubmed
20. Carcas AJ, Borobia AM, Velasco M, Abad-Santos F, Quintana Díaz M, Fernández- Capitán C, et al. Efficiency and effectiveness of the use of an acenocoumarol pharmacogenetic dosing algorithm versus usual care in patients with venous thromboembolic disease initiating oral anticoagulation: study protocol for a randomized oral trial. Trials [Internet]. 2012 [citado 14 Ago 2023];13:239. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3543328/
Published
How to Cite
Issue
Section
License
Copyright: Camagüey Medical Archive Magazine, offers immediately after being indexed in the SciELO Project; Open access to the full text of the articles under the principle of making available and free the research to promote the exchange of global knowledge and contribute to a greater extension, publication, evaluation and extensive use of the articles that can be used without purpose As long as reference is made to the primary source.
Conflicts of interest: authors must declare in a mandatory manner the presence or not of conflicts of interest in relation to the investigation presented.
(Download Statement of potential conflicts of interest)
The Revista Archivo Médico de Camagüey is under a License Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 International (CC BY 4.0).
This license allows others to distribute, to mix, to adjust and to build from its work, even for commercial purposes, as long as it is recognized the authorship of the original creation. This is the most helpful license offered. Recommended for maximum dissemination and use of licensed materials. The full license can be found at: https://creativecommons.org/licenses/
22 julio 2025