Shiv
Well-known member
Anyone on acitrom? How is acitrom different from warfarin with respect to half life, duration and onset of action and pharmacokinetics?
ACITROM- does anyone take ACITROM here? Or all are on warfarin.
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pellicle
Professional Dingbat, Guru and Merkintologist
Acitrom is Acenocoumarol, which is the drug of choice in 3rd world countries (for reasons which I have zero good explanations). I would strongly recommend you move to warfarin
Alternative anticoagulants
In some countries, other coumarins are used instead of warfarin, such as acenocoumarol and phenprocoumon. These have a shorter (acenocoumarol) or longer (phenprocoumon) half-life, and are not completely interchangeable with warfarin.
because of the very short half life you will be constantly dipping in and out of INR ... myself I wouldn't give it to a dog, but that's me.
Alternative anticoagulants
In some countries, other coumarins are used instead of warfarin, such as acenocoumarol and phenprocoumon. These have a shorter (acenocoumarol) or longer (phenprocoumon) half-life, and are not completely interchangeable with warfarin.
because of the very short half life you will be constantly dipping in and out of INR ... myself I wouldn't give it to a dog, but that's me.
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I also take acitrom alternate 5.5 /5 mg daily and 75 mg aspirin . So far I have been able to keep by INR between 2 and 3 . I test weekly at home using Coaguchek and do a lab test once in 3 months . Noticed only a 0.2 diff in INR between coaguchek and lab report .
Shiv
Well-known member
Good to know that coaguchek is accurate. I am taking 3mg daily as of now. If INR keep going up, I will reduce to 2.5 mg for 5 days and 3mg for 2 days. You are on quite high acitrom dose compared to me. Genetic differences may be.
Shiv
Well-known member
Acitrom is given in Spain which is no 3rd world country. Acitrom is equal to warfarin in INR control. And time in therapeutic range.
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Shiv
Well-known member
Today read some articles..which confirm..acitrom is non inferior to warfarin..we can chose any. No need to provide superiority.
pellicle
Professional Dingbat, Guru and Merkintologist
Dear Shiv
as you know I've spent many hours responding to your (quite incessant and demanding) requests. Fishing out data and corresponding via WhatsApp sometimes for hours.
I thoughtfully advised you and we worked through the concern you had with the discrepancy of reading from your Coaguchek and the Lab (it was the lab).
After providing much information on the reasons I have for my opinion on Acenocoumarol you failed to read them and focused only on the parts of the studies and the commercial advertising materials from the drug company which you wished to believe. Further its my opinion, you do not need to share my opinion. You will find many medical professionals who have differing opinions.
Next, I asked you many times on our chat to cease this conversation about Acenocoumarol on WhatsApp but you persisted. I warned you that I would stop communicating with you about it and when you reacted badly I acted upon that warning.
I do not mind that you post about it here, because you're free to express your own opinion on the efficacy of Acenocoumarol, this is based on the review of about a half dozen journal published papers. If anyone else wants those notes (because many read these posts) then please reach out by PM here and I will share them
Its important to note that you have not been honest from the start here on this forum. You have pretended to be a pregnant woman when in fact it was your wife (and she had the baby and happily it is doing fine).
I understand Indian culture reasonably well and the hierarchy between men and women, I understand also that your wife may not speak English. But to pretend to be your wife for this purpose is not what westerners will call honest.
You will find many people here posting on behalf of a spouse or a child, the difference is that they put that up front.
We have a saying in the west:
Throughout that you seemed to show no regard or respect for how much effort I put into this for you. I am not your servant, it is only due to my concern for valvers that I do what I do.
Good bye and I hope your wife does well.
as you know I've spent many hours responding to your (quite incessant and demanding) requests. Fishing out data and corresponding via WhatsApp sometimes for hours.
I thoughtfully advised you and we worked through the concern you had with the discrepancy of reading from your Coaguchek and the Lab (it was the lab).
After providing much information on the reasons I have for my opinion on Acenocoumarol you failed to read them and focused only on the parts of the studies and the commercial advertising materials from the drug company which you wished to believe. Further its my opinion, you do not need to share my opinion. You will find many medical professionals who have differing opinions.
Next, I asked you many times on our chat to cease this conversation about Acenocoumarol on WhatsApp but you persisted. I warned you that I would stop communicating with you about it and when you reacted badly I acted upon that warning.
I do not mind that you post about it here, because you're free to express your own opinion on the efficacy of Acenocoumarol, this is based on the review of about a half dozen journal published papers. If anyone else wants those notes (because many read these posts) then please reach out by PM here and I will share them
Its important to note that you have not been honest from the start here on this forum. You have pretended to be a pregnant woman when in fact it was your wife (and she had the baby and happily it is doing fine).
I understand Indian culture reasonably well and the hierarchy between men and women, I understand also that your wife may not speak English. But to pretend to be your wife for this purpose is not what westerners will call honest.
You will find many people here posting on behalf of a spouse or a child, the difference is that they put that up front.
We have a saying in the west:
Fool me once shame on your, fool me twice shame on me
Throughout that you seemed to show no regard or respect for how much effort I put into this for you. I am not your servant, it is only due to my concern for valvers that I do what I do.
Good bye and I hope your wife does well.
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Shiv
Well-known member
Why u want to prove u r the best which u aren't. People have different views, and in many studies it is proved acenocoumarol is non inferior to warfarin..but because you take warfarin so it has to be superior..this is non sense. And when someone don't buy your idea or just discuss about it , you get angry...its so childish.and funny..u are such a egoistic.. anyway who cares..
Regarding fooling. I have not fooled anyone..yes my wife is a female (TRUTH) ...and she was pregnant(TRUTH)..she Had a baby on 14th Jan on- x valve (TRUTH).she takes acitrom(TRUTH)..all is pure truth.. just because she is not posting all this..she is not well versed with English.. does that mean fooling? How does it matter If his husband is posting unless I am posting wrong facts. Why would I fool anyone here? What will I get? Come on, give me a break.
You are from Australia and I am indian, so don't feel you are superior..don't be a racist. Please. Grow up.
Shame ful that you could not accept some facts and stopped communicating . This screenshot says it all how abruptly you blocked me for no reasons? I was surprised and said oh my god, and then said ok I wont , and I was blocked..This shows you are fooling here all.
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Shiv
Well-known member
Shiv
Well-known member
Shiv
Well-known member
I am blocking/ignoring you in this forum as I am not interested in your biased views..good bye..take care of your valve.
Shiv
Well-known member
I wonder how you became my servant. Helping each other, does this make us servant? I don't know what wrong notions and thinking you have inculcated. In india, we help each other and don't mention of it as we all are brothers and facing same life issues. I thought we are suffering from same disease so you are helping me out of concern. But you wanted respect ( ACTUALLY EGO SATISFACTION)! So many times I told on whatsapp..THANK YOU SO MUCH CHRIS...is this disrespect? I think you are trying to fool us. Good bye. You blocked me on whatsapp for no valid reasons.. I am blocking you here..GOOD BYE.
pellicle
Professional Dingbat, Guru and Merkintologist
all pure selections of truth. Except that what I said is correct, and what is found in replies that you can not now edit
Shiv
Well-known member
Hi brijesh, please Switch to warfarin...acenocoumarol is so bad (AS PER PELLICLE)..you know a guy pelicle he won't give acenocoumarol to his dog..but thats him
bluetux
Member
I also take Acenocoumarol ( Sintrom 4mg Medius, Switzerland; Merus Labs, Luxembourg) 5 mg/5days, 4 mg/2days /week. hard to get INR 2-3, indeed, I'll ask the cardiologist to recommend something else...
I also take Aspenter (aspirin) 75, daily...
I also take Aspenter (aspirin) 75, daily...
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pellicle
Professional Dingbat, Guru and Merkintologist
Hi
well here is the basis of my case against it:
1) stability
Basically the body works on one principle guiding things: homeostasis , the body likes things to be reasonably constant and has many biochemical reactions to try to keep that happening, including the chemical reactions to rid it of toxins. If a toxin is introduced (warfarin is one) then it sets up a reaction that metabolises it out of the body. When that is cleared it then shuts that mechanism down.
The half life of the durg acenocoumarol is short, such that it will be pretty much entirely cleared by the body : (link)
So the machinery to clear it (which is metabolically costly to keep running) will be shut down when its complete, meaning it has to start again the next dose. Perhaps it would be wise to consider dosing every 4 hours, but I've never seen anyone set that up. Probably because nobody in medicine give a rats arse, and if they did they'd simplify it back to a single daily dose of something with a longer half life (like warfarin).
{part 1}
well here is the basis of my case against it:
1) stability
Basically the body works on one principle guiding things: homeostasis , the body likes things to be reasonably constant and has many biochemical reactions to try to keep that happening, including the chemical reactions to rid it of toxins. If a toxin is introduced (warfarin is one) then it sets up a reaction that metabolises it out of the body. When that is cleared it then shuts that mechanism down.
The half life of the durg acenocoumarol is short, such that it will be pretty much entirely cleared by the body : (link)
The elimination half-life of acenocoumarol from the plasma is 8 to 11 hours.
So the machinery to clear it (which is metabolically costly to keep running) will be shut down when its complete, meaning it has to start again the next dose. Perhaps it would be wise to consider dosing every 4 hours, but I've never seen anyone set that up. Probably because nobody in medicine give a rats arse, and if they did they'd simplify it back to a single daily dose of something with a longer half life (like warfarin).
{part 1}
pellicle
Professional Dingbat, Guru and Merkintologist
2) suitability and effectiveness
If the purpose of use is for mechanical heart valve patients (unlike say treatment of DVT or AFib) then its well established in the literature that Time in Therapeutic Range (TTR) is critical for good outcomes, the more time the better.
Most people don't read the medical literature, fewer do more than read the abstract or conclusions, even fewer understand the peer review process (who reads it, what passes and what fails and why).
Since there are relatively few journal articles supporting the use of acenocoumraol we have an easy task ahead. Lets start with this one:
https://pubmed.ncbi.nlm.nih.gov/18590623/
which you'll note is originally in Spanish, which both reduces the potential breadth of reviewers and the audience.
If we skip directly (as many do) to the conclusions we see this:
Conclusions: Patients treated with acenocoumarol show a higher risk of presenting with an INR > or = 6, but no statistically significant differences are observed in therapeutic stability.
looks good doesn't it ... unless you think like "whooaaaa: INR > 6 ... what the actual"
The first hints of "you are kidding me right" lie directly in the results (but you have to actually have some cognitive process occur when you see that:
The percentage of visits within the intended range of INR (2 to 3) was 65.5% with warfarin and 63.4% with acenocoumarol.
and go "like what the actual? less than 60% in range ... that's a dreadful baseline to accept"
Welcome to the same pattern you'll see emerge on every article which investigates the suitablity of acenocoumarol: the presumpition that "inadequate is good enough for youpigs {peer reviewer: you cant' call them that} patients"
The next line following just highlights the ineptitude of the anti-coagulation management:
Thirty percent of patients on warfarin had 75% or more of their controls within range, while for those treated with acenocoumarol this percentage was 22.5%.
So because of the rapid up and down of INR when on acenocoumarol people who have no real dose control and AC management is clearly totally dysfunctional esentially have lower time in "the outer limits" of over dose (perhaps because they came in and had an INR test 12 hours after dose?).
This is already shaping up as a very bad basis for making a decision of "Its all good"
So lets move on to an article which (sadly) is used in the citations of other "its all good" studies (reviewers seldom check if the citation is actually pertinate, especially if the reviewer is mates with the authors)
https://www.revespcardiol.org/en-control-of-anticoagulation-with-warfarin-articulo-S1885585715003485
Right at the top they make the declaration:
Although warfarin is the most widely used VKA, in some countries, acenocoumarol or phenprocoumon are used.
So basically what is their research assumption? Is it "warfarin is the most widely used but we want to be different?"
Worth noting that phenprocoumon is even more stable than warfarin and has a half life of 5 days (not 48 hours).
The article then says:
In Spain, the most widely used VKA is acenocoumarol. However, most of the available evidence on the efficacy and safety of VKAs is derived from warfarin. The results obtained with this VKA have in general been extrapolated to the other VKAs.
ok, so they extrapolated this ... that's about as valid as extrapolating the dangers of walking with the dangers or running.
Then it gets worse:
PAULA is a cross-sectional study whose objective was to determine the degree of anticoagulation control in the preceding 12 months in patients with nonvalvular atrial fibrillation who received anticoagulation therapy with a VKA in the primary health care setting in Spain ... The objective of the present analysis was to determine whether there were differences in the clinical profile, anticoagulation control, and thromboembolic/bleeding events according to type of VKA.
I've bolded the relevant point ... we should need to go no further and should have discounted this in our supporting literature.
Reading further we again see the same misreably low bar of TTR
Control of Anticoagulation and Events in the PAULA Study
(bolding of results mine)
We are seeing a trend here ... for the authors of these papers totally unacceptable levels of TTR are acceptable Even the clinics in the USA which are maligned by members here achieve higher than 70%
Again here:
https://pubmed.ncbi.nlm.nih.gov/9869157/
We wished to know whether warfarin could improve the quality and the stability of oral anticoagulation of our patients and whether there was a difference between the two drugs in the weekly mean dose per patient. ... The percentage of PTs in the therapeutic range was 59% with acenocoumarol and 62% with warfarin (p=0.4). The mean number of visits per patient was 12 and 11, and the mean number of visits in the therapeutic range was 7 and 7, respectively.
again, the proponents of acenocoumarol are still willing to accept this low bar, as they say:
Our results showed that {pellicle: miserably manged} warfarin did not appear to be better than acenocoumarol in the performance of an Anticoagulation Clinic in terms of PTs within the therapeutic range per patient.
Bottom line:
for me its an irrelevant discussion because quite simply in Australia (like the UK, the USA and other countries) the use of acenocoumarol is not approved for use as an anticoagulant for valvular heart patients. I presume that minds better than mine have reviewed the literature and chosen warfarin (pick your personal product name for that) provides better results.
Comment
In my time in assisting valvers with their INR I have had 100% success in helping warfarin patients get better than 90% TTR, but I have worked with only two patients on acenocoumarol and both have reached out because neither they nor their clinics could keep better than 60% TTR and they were concerned. One such fellow lives in South America and has been (in our discussions) both diligent and rigorous in his data collection, measurement frequency and documentation.
Finally I will refer you to my blog post here, which discusses a few points around AC Therapy in general, none of which can be attained with a short half life drug like acenocoumarol
http://cjeastwd.blogspot.com/2014/05/inr-management-goldilocks-dose.html
Best Wishes
If the purpose of use is for mechanical heart valve patients (unlike say treatment of DVT or AFib) then its well established in the literature that Time in Therapeutic Range (TTR) is critical for good outcomes, the more time the better.
Most people don't read the medical literature, fewer do more than read the abstract or conclusions, even fewer understand the peer review process (who reads it, what passes and what fails and why).
Since there are relatively few journal articles supporting the use of acenocoumraol we have an easy task ahead. Lets start with this one:
https://pubmed.ncbi.nlm.nih.gov/18590623/
which you'll note is originally in Spanish, which both reduces the potential breadth of reviewers and the audience.
If we skip directly (as many do) to the conclusions we see this:
Conclusions: Patients treated with acenocoumarol show a higher risk of presenting with an INR > or = 6, but no statistically significant differences are observed in therapeutic stability.
looks good doesn't it ... unless you think like "whooaaaa: INR > 6 ... what the actual"
The first hints of "you are kidding me right" lie directly in the results (but you have to actually have some cognitive process occur when you see that:
The percentage of visits within the intended range of INR (2 to 3) was 65.5% with warfarin and 63.4% with acenocoumarol.
and go "like what the actual? less than 60% in range ... that's a dreadful baseline to accept"
Welcome to the same pattern you'll see emerge on every article which investigates the suitablity of acenocoumarol: the presumpition that "inadequate is good enough for you
The next line following just highlights the ineptitude of the anti-coagulation management:
Thirty percent of patients on warfarin had 75% or more of their controls within range, while for those treated with acenocoumarol this percentage was 22.5%.
So because of the rapid up and down of INR when on acenocoumarol people who have no real dose control and AC management is clearly totally dysfunctional esentially have lower time in "the outer limits" of over dose (perhaps because they came in and had an INR test 12 hours after dose?).
This is already shaping up as a very bad basis for making a decision of "Its all good"
So lets move on to an article which (sadly) is used in the citations of other "its all good" studies (reviewers seldom check if the citation is actually pertinate, especially if the reviewer is mates with the authors)
https://www.revespcardiol.org/en-control-of-anticoagulation-with-warfarin-articulo-S1885585715003485
Right at the top they make the declaration:
Although warfarin is the most widely used VKA, in some countries, acenocoumarol or phenprocoumon are used.
So basically what is their research assumption? Is it "warfarin is the most widely used but we want to be different?"
Worth noting that phenprocoumon is even more stable than warfarin and has a half life of 5 days (not 48 hours).
The article then says:
In Spain, the most widely used VKA is acenocoumarol. However, most of the available evidence on the efficacy and safety of VKAs is derived from warfarin. The results obtained with this VKA have in general been extrapolated to the other VKAs.
ok, so they extrapolated this ... that's about as valid as extrapolating the dangers of walking with the dangers or running.
Then it gets worse:
PAULA is a cross-sectional study whose objective was to determine the degree of anticoagulation control in the preceding 12 months in patients with nonvalvular atrial fibrillation who received anticoagulation therapy with a VKA in the primary health care setting in Spain ... The objective of the present analysis was to determine whether there were differences in the clinical profile, anticoagulation control, and thromboembolic/bleeding events according to type of VKA.
I've bolded the relevant point ... we should need to go no further and should have discounted this in our supporting literature.
Reading further we again see the same misreably low bar of TTR
Control of Anticoagulation and Events in the PAULA Study
| Variable | Acenocoumarol (n=1445) | Warfarin (n=79) | P |
|---|---|---|---|
| Control of anticoagulation | |||
| Time in therapeutic range (direct method), % | 61.1±0.59 | 64.3±2.0 | .57 |
| Time in therapeutic range (Rosendaal method), % | 67.9±0.58 | 68.3±2.1 | .72 |
| Acceptable anticoagulation control (direct method), % | 56.2±1.6 | 60.0±5.5 | .56 |
| Acceptable anticoagulation control (indirect method), % | 58.3±1.6 | 60.0±5.5 | .82 |
| Number of visits to primary care | 5.9±0.07 | 5.5±0.61 | .06 |
| Number of visits to the specialist | 1.1±0.17 | 0.86±0.20 | .24 |
| Events | |||
| Thromboembolic complications, % | 0.28±0.3 | 0 | .52 |
| Bleeding complications, % | 1.5±0.4 | 1.3±1.2 | .72 |
| Cardiovascular events, % | 2.4±0.5 | 0 | .16 |
(bolding of results mine)
We are seeing a trend here ... for the authors of these papers totally unacceptable levels of TTR are acceptable Even the clinics in the USA which are maligned by members here achieve higher than 70%
Again here:
https://pubmed.ncbi.nlm.nih.gov/9869157/
We wished to know whether warfarin could improve the quality and the stability of oral anticoagulation of our patients and whether there was a difference between the two drugs in the weekly mean dose per patient. ... The percentage of PTs in the therapeutic range was 59% with acenocoumarol and 62% with warfarin (p=0.4). The mean number of visits per patient was 12 and 11, and the mean number of visits in the therapeutic range was 7 and 7, respectively.
again, the proponents of acenocoumarol are still willing to accept this low bar, as they say:
Our results showed that {pellicle: miserably manged} warfarin did not appear to be better than acenocoumarol in the performance of an Anticoagulation Clinic in terms of PTs within the therapeutic range per patient.
Bottom line:
for me its an irrelevant discussion because quite simply in Australia (like the UK, the USA and other countries) the use of acenocoumarol is not approved for use as an anticoagulant for valvular heart patients. I presume that minds better than mine have reviewed the literature and chosen warfarin (pick your personal product name for that) provides better results.
Comment
In my time in assisting valvers with their INR I have had 100% success in helping warfarin patients get better than 90% TTR, but I have worked with only two patients on acenocoumarol and both have reached out because neither they nor their clinics could keep better than 60% TTR and they were concerned. One such fellow lives in South America and has been (in our discussions) both diligent and rigorous in his data collection, measurement frequency and documentation.
Finally I will refer you to my blog post here, which discusses a few points around AC Therapy in general, none of which can be attained with a short half life drug like acenocoumarol
http://cjeastwd.blogspot.com/2014/05/inr-management-goldilocks-dose.html
Best Wishes
Shiv
Well-known member
I am on acitrom. My TTR is 92% on Acitrom.
Superman
Well-known member
You mean your wife is on acitrom, correct? Her TTR is 92%?
Unless you’re sharing an account, it’s confusing to follow.
bluetux
Member
Warfarin has high toxicity and severe adverse reactions, therefore, in the course of the discovery of other anticoagulants, it has been abandoned on a large scale. It is currently used as a poison for mice, so in no case should it be administered to the dog
