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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 Tue, 21 Jan 2014
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.
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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.