What Are the Different Types of Oral Anticoagulants and Which Are Their Main Properties and Action Mechanisms?
Oral anticoagulants, or vitamin K antagonists, are coumarins or indanedione derivatives. Coumarins produce fewer nonhemorrhagic complications and are now used exclusively. Warfarin (4-hydroxycoumarin) is the most widely used. The vitamin K antagonists exert their anticoagulant effect by inhibiting vitamin K epoxide reductase and possibly vitamin K reductase. These processes lead to the depletion of vitamin KH2, limit the carboxylation, and also lead to the impairment of the function in vitamin-K-dependent coagulant proteins (prothrombin, factor VII, factor IX and factor X). Moreover, the vitamin K antagonists limit the carboxylation of the regulatory proteins such as protein C and protein S, and therefore impair their functions. Warfarin is used widely because its onset and duration of action are predictable and it has excellent bioavailability. It is almost always administered orally and is rapidly absorbed by the gastrointestinal tract and reaches maximal blood concentrations in 90 m
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