Acenocoumarol

Acenocoumarol is an oral anticoagulant that antagonizes the effects of vitamin K. It prevents the synthesis of active forms of vitamin K-dependent coagulation factors II, VII, IX, and X, and proteins C and S, which are synthesized in the liver. The full anticoagulant effect typically develops over at least 48 to 72 hours.

Adult

Loading: 8–12 mg; Maintenance: 2–8 mg

Hepatic adjustment

Manufacturers advise caution in mild to moderate hepatic impairment; avoid in severe impairment.

Geriatric

Prescription potentially inappropriate for elderly patients with: concurrent significant bleeding risk (such as uncontrolled severe hypertension, bleeding diathesis, or recent non-trivial spontaneous bleeding), dual therapy with an antiplatelet agent in patients with stable coronary, cerebrovascular, or peripheral arterial disease without a clear indication for anticoagulant therapy, or for first…

• First trimester of pregnancy
• Severe hepatic impairment
• Cerebral artery thrombosis as first-line therapy
• Peripheral artery occlusion as first-line therapy
• Hyperthyroidism
• Peptic ulcer
• Postpartum (delay until risk of haemorrhage is low, usually 5–7 days after delivery)
• Recent ischaemic stroke
• Recent surgery
• Uncontrolled hypertension
• Concurrent significant bleeding risk (e.g., uncontrolled severe hypertension, bleeding diathesis, recent non-trivial spontaneous bleeding) in the elderly
• Dual therapy with an antiplatelet agent in patients with stable coronary, cerebrovascular, or peripheral arterial disease without a clear indication for anticoagulant therapy in the elderly
• For first deep venous thrombosis without continuing provoking risk factors for longer than 6 months in the elderly
• For first pulmonary embolus without continuing provoking risk factors for longer than 12 months in the elderly