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Concept
Phenprocoumon
Summary
Phenprocoumon (marketed under the brand names Marcoumar, Marcumar and Falithrom) is a long-acting blood thinner drug to be taken by mouth, and a derivative of coumarin. It acts as a vitamin K antagonist and inhibits blood clotting (coagulation) by blocking synthesis of coagulation factors II, VII, IX and X. It is used for the prophylaxis and treatment of thromboembolic disorders such as heart attacks and pulmonary (lung) embolism. The most common adverse effect is bleeding. The drug interacts with a large number of other medications, including aspirin and St John's Wort. It is the standard coumarin used in Germany, Austria, and other European countries.
Phenprocoumon is used for the prophylaxis and treatment of thromboembolic disorders after heart bypass surgery and myocardial infarction (heart attack), long-term treatment of myocardial infarction with increased risk of thromboembolism, thrombophilia (abnormal blood clotting), antithrombin III deficiency, atrial fibrillation (a kind of abnormal heart rhythm) with artery embolisms, after venous thrombosis, pulmonary embolism and artificial heart valve surgery, as well as chronic ventricular aneurysm (bulging of the heart wall) and congestive cardiomyopathy (enlarged heart).
When phenprocoumon therapy is started, the clotting tendency of the blood is measured daily by determining the prothrombin time, more specifically the international normalized ratio (INR). After the desired INR has been reached, which typically takes five to six days, intervals between measurements are increased to twice or three times a week for a week or two, then to two to four weeks if the patient is stable. INR monitoring continues throughout the therapy, often for life. This is necessary because people need different doses depending on the genetic makeup of their enzymes, activity of coagulation factors, vitamin K concentrations in the body, other drugs, and diet.
If a fast onset of action is needed, as after an acute thromboembolism, phenprocoumon therapy has to be accompanied with a subcutaneous or intravenous low-molecular-weight heparin (LMWH) for the first 36 to 72 hours.
Official source
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