What does this research mean for the field?

Acenocoumarol remains an essential anticoagulant in specific clinical scenarios despite the rise of direct oral anticoagulants (DOACs). Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

To review the historical development, pharmacological properties, dosing challenges, and contemporary clinical role of the vitamin K antagonist acenocoumarol in the era of direct oral anticoagulants.

February 27, 2026SHILAP Revista de lepidopterologíaOpen Access

Acenocoumarol – a historical overview and its place in modern anticoagulant therapy

Q: What is the clinical evidence from this study?

Study design: Review. Population: Patients with venous thromboembolism requiring anticoagulation with use of acenocoumarol (n=204). Intervention: Acenocoumarol pharmacogenetic dosing algorithm vs. Usual care dosing. Primary outcome: Achieving therapeutic INR range with personalized pharmacogenetic dosing algorithm versus usual care (Not explicitly stated).

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Key result

Pharmacogenetic acenocoumarol dosing improves safety and INR control in VTE patients.

Not explicitly stated
n=204

Why the study?

Despite the widespread adoption of direct oral anticoagulants, acenocoumarol continues to hold clinical significance, motivating an overview of its historical role, precision dosing strategies, and place in modern anticoagulant therapy.

Key Points

To review the historical development, pharmacological properties, dosing challenges, and contemporary clinical role of the vitamin K antagonist acenocoumarol in the era of direct oral anticoagulants.
Narrative review synthesizing more than 60 years of pharmacological and clinical evidence for acenocoumarol.
Evaluation of pharmacokinetics, pharmacogenomics (CYP2C9 and VKORC1), and dosing optimization strategies.
Comparative analysis against direct oral anticoagulants using data from major trials including RE-LY, ROCKET AF, ARISTOTLE, ENGAGE AF-TIMI 48, RE-ALIGN, FRAIL-AF, and INVICTUS.
Acenocoumarol rapidly reaches peak plasma concentrations within 1 to 3 hours with a half-life of 8 to 11 hours, offering faster onset and offset than warfarin.
Therapeutic efficacy requires regular monitoring of the international normalized ratio due to dietary influences, drug interactions, chronic kidney disease, and genetic variants in CYP2C9 and VKORC1.
Despite the convenience of direct oral anticoagulants, acenocoumarol remains indispensable for patients with mechanical heart valves, rheumatic mitral stenosis–associated atrial fibrillation, and antiphospholipid syndrome.

Structured PICO

Population

Patients requiring anticoagulant therapy for conditions such as venous thromboembolism, atrial fibrillation, mechanical heart valves, left ventricular assist devices, and antiphospholipid syndrome

Intervention

Acenocoumarol (vitamin K antagonist)

Comparator

Direct oral anticoagulants (DOACs) and warfarin

Main Result

Effect estimate: Not explicitly stated

Acenocoumarol maintains a critical role in modern anticoagulant therapy for specific high-risk indications where DOACs are contraindicated or lack proven efficacy.

Limitations

No precise outcome effect sizes or results reported
Data primarily from reviews and comparisons with warfarin and DOACs
Lack of randomized controlled trial data specific to acenocoumarol in this review
Population characteristics such as age and gender percentages not specified

Discussion

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Implication

Supports pharmacogenetic dosing of acenocoumarol in VTE; reinforces consensus where DOACs are contraindicated.

Cite This Study

D. Farandzha (2025) 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.

synapsesocial.com/papers/69a1344fed1d949a99abe085 https://doi.org/10.3897/bgcardio.31.e178367

Topics

Anticoagulation in AF

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Acenocoumarol – a historical overview and its place in modern anticoagulant therapy

Key Points

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Topics

Acenocoumarol – a historical overview and its place in modern anticoagulant therapy

Key Points

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider