Use of a pharmacogenetic dosing algorithm for acenocoumarol improved individualized dosing, enhancing safety and INR control in patients with venous thromboembolism.
Acenocoumarol maintains a critical role in modern anticoagulant therapy for specific high-risk indications where DOACs are contraindicated or lack proven efficacy.
Effect estimate: Not explicitly stated
Acenocoumarol, a vitamin K antagonist (VKA), has played a pivotal role in anticoagulant therapy for over 60 years. Derived from the coumarin family, acenocoumarol inhibits vitamin K epoxide reductase, disrupting the synthesis of vitamin K-dependent clotting factors (II, VII, IX, X) and effectively preventing thromboembolic events. Compared to warfarin, acenocoumarol offers a rapid onset and shorter half-life, providing clinicians greater therapeutic exibility. Despite advances and widespread adoption of direct oral anticoagulants (DOACs), acenocoumarol continues to hold clinical signi cance, particularly in Europe, Latin America, and Asia, owing to extensive clinical experience, reversibility, and cost-effectiveness. However, its use necessitates regular monitoring of international normalized ratio (INR), with individualized dosage adjustments required due to genetic variability (CYP2C9, VKORC1 polymorphisms), drug-drug interactions, dietary in uences, and special considerations in the elderly and patients with chronic kidney disease (CKD). Recent clinical trials have expanded our understanding of its ef cacy, safety, and optimal use. Precision dosing strategies, including genotype guidance and advanced INR monitoring based on body-surface area-adjusted estimated glomerular ltration rate (BSA-adjusted eGFR) dosing, promise enhanced safety and personalized treatment. Although DOACs are now widely adopted due to their predictable pharmacokinetics and lack of routine monitoring requirements, acenocoumarol remains indispensable in well-de ned clinical scenarios such as in patients with mechanical heart valves, rheumatic mitral stenosisassociated atrial brillation, antiphospholipid syndrome, and other conditions in which individualized dose adjustment offers a therapeutic advantage.
D. Farandzha (Wed,) conducted a review in Patients with venous thromboembolism requiring anticoagulation with use of acenocoumarol (n=204). Acenocoumarol pharmacogenetic dosing algorithm vs. Usual care dosing was evaluated on Achieving therapeutic INR range with personalized pharmacogenetic dosing algorithm versus usual care (Not explicitly stated). Use of a pharmacogenetic dosing algorithm for acenocoumarol improved individualized dosing, enhancing safety and INR control in patients with venous thromboembolism.