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lunes, 4 de junio de 2007

Algunas curiosidades sobre los anticoagulantes orales

Eng

Al igual que otras muchas bitácoras científicas que aspiramos a tener un mínimo de calidad (vaya farol ;-) ), CyL puede presumir de contar entre sus lectores con muchos realmente geniales, que nos dejan comentarios que puntualizan, enriquecen y corrigen las entradas de esta humilde escribiente.

Uno de ellos, Ortiga, dejó hace poco una aportación en la entrada de los medicamentos de origen natural, que no me gustaría que se perdiera en el blog, y que paso a copiar a continuación. El autor nos relata varias curiosidades de uno de los medicamentos anticoagulantes más utilizados en la actualidad: el acenocumarol (si miran en los botiquines de sus abuelos probablemente lo encuentren), su descubrimiento y otros interesantes usos que tiene más allá de la medicina.

Añado algunas negritas y enlaces, pero no cambio ni una coma:

Uno de los medicamentos de origen vegetal es el acenocumarol, antiacoagulante oral muy usado; es un antagonista de la vitamina K y por tanto inhibe la formación de varios factores de la coagulación. Pertenece al grupo de las cumarinas, que tienen varias cosas interesantes y curiosas a su alrededor. Esta comercializado en España y otros países como Sintrom® por Novartis (¡hay Novartis, lo que estás haciendo contra la India por la patente del Glivec®!) y pocas personas mayores desconocen su existencia. La razón es que es prescrito con profusión a personas con antecedentes coronarios.

No resulta fácil acertar con la dosis adecuada para cada paciente, dada la característica de estos fármacos, que es la total ausencia de relación lineal dosis-efecto, con los peligros que tiene de ineficacia (si la dosis es muy baja) o de hemorragias (si la dosis es muy alta). Para ello deben acudir con cierta frecuencia a realizarse controles analíticos para determinar el tiempo de hemorragia o algún parámetro analítico similar y posteriormente el médico poder ajustar la dosis. Por ello, uno puede ver en los laboratorios de cualquier hospital español, a primera hora de la mañana a decenas de personas esperando “para pincharse” agrupados en dos colas; una de ellas es “la del sintrom”. No es de extrañar pues se estima que en España hay casi ¡medio millón de personas tratadas con anticoagulante orales!

¿Y cuál es el origen vegetal de las cumarinas?: en los años 20 se describe en Canadá y EE.UU. la enfermedad del trébol dulce fermentado, que afecta al ganado bovino alimentado con dicho producto, produciendo hemorragias digestivas. A partir de este hecho, un avispado científico, Paul Karl Link consigue en 1941 aislar el dicumarol, un compuesto volátil (es el olor que notamos al cortar la hierba) y trata con esta sustancia a los primeros pacientes. En 1953, Link con un grupo de alumnos desarrolla la warfarina cuyo nombre son las siglas de Wisconsin Alumnae Research Foundation Coumarin.

Por último ya -y no menos simpático- es que varios compuestos del grupo de las cumarinas, son usados como raticidas desde hace años, provocando la muerte de roedores por hemorragias internas que ocurren varios días después de la ingesta del producto con lo que estos animales no pueden asociarlo a su consumo.

Enlace | Más información sobre los anticoagulantes orales
En CyL | Metanfetamina en la farmacia


23 comentarios:

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Sencillo y completito. Muy bueno.
Te agrego alguna cosita: es utilizado tambièn en pacientes que han sufrido trombosis venosas profundas, y en los ancianos, màs que el antecedente coronario (para los que en general se utilizan agentes que alteran la funcionalidad plaquetaria como la aspirina o el clopidogrel)la fibrilaciòn auricular es una indicaciòn cotidiana. Lo màs adecuado es regular la dosis sin alterar la alimentaciòn del paciente, algunos les quitan toda fuente de vitamina K, con lo que los constipan e incomodan innecesariamente. Respetar al paciente y avisarle que si hay un cambio radical en su dieta (era un carnìvoro y se convirtiò de repente en un vegetariano militante, o viceversa)tiene que controlarse y seguramente adecuar la dosis. El aceite de soja tiene mucha vitamina K,en ocasiones, por el precio, el paciente cambia nada màs que de aceite, y ahì sus tiempos se acortan con peligro de trombosis ¿Qué tiempos? el de Protrombina que es el único análisis que se debe tener en cuenta (mide específicamente los factores vitamina K dependientes) y se informa como RIN, que es un valor que surge de una serie de datos, el principal de los cuales lo debe poner el fabricante del reactivo a utilizarse en el frasco del mismo. Cada nuevo envase que se usa requiere el cálculo de una nueva tabla de RIN. Los valores habituales son entre 2,0 y 3,0 de RIN, aunque para los que tienen vàlvulas cardiacas mecànicas se establece entre 2,5 y 3,5 del valor internacional normalizado (RIN)de esa manera se puede controlar en cualquier lugar del mundo y si siguen el estàndar no tendrá inconvenientes con los resultados. Hasta la próxima.

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