Studies on the stability sensitivity and resistance of oral anticoagulant drugs with reference to extrinsic and genetic factors

Abstract

Anticoagulants, including Vitamin K antagonists (VKAs) like acenocoumarol, are vital for preventing conditions like cerebral venous thromboembolism and arterial embolic stroke. VKAs have a rich history, originally discovered due to a peculiar event involving cows in the early 20th century. These compounds, derived from 4-hydroxycoumarin, became essential components of oral anticoagulant drugs. VKAs are used in various medical conditions, from stroke prevention to myocardial infarction. While VKAs have proven effective, they come with limitations. Their therapeutic range is narrow, demanding precise dosage control to avoid under- or over-anticoagulation. People exhibit significant pharmacokinetic variations, complicating dosing. VKAs are sensitive to vitamin K intake, and concurrent medications can affect their levels in the bloodstream. Maintaining a stable International Normalized Ratio (INR), a measure of clotting time is challenging. In neurology, OACs are essential for primary and secondary stroke prevention, atrial fibrillation management, and treating conditions like prosthetic mechanical heart valves, dilated cardiomyopathy, and central venous sinus thrombosis (CVST).INR control is complex due to numerous influencing factors, including diet, alcohol use, comedication, and individual genotype. Genes like CYP2C9 and VKORC significantly impact dosage requirements and the variants can help categorize patients as rapid, intermediate, or slow responders to OAC drugs, while the VKORC1 gene affects VKOR activity and dosing. newline This study aims to assess the quality of oral anticoagulation in patients with neurological conditions, a field that has seen limited research. Effective anticoagulation depends on maintaining a stable level of these drugs in the body. Given the scarcity of studies focused on neurological patients, the research hypothesis centers on evaluating the stability of oral anticoagulation in this specific patient group. This study goes beyond genetics and explores the influence of stress.