Marcumar® for atrial fibrillation
Marcumar® is the drug of choice for atrial fibrillation. Atrial fibrillation is a circular excitation in the two atria of the heart. As a result, some parts of the atria stand still and no longer take part in the contraction.
The atria contain the so-called heart ears. They are hollow spaces in the atria in which blood can collect due to reduced emptying of the atria. This causes the blood to come to a standstill and then coagulate.
The result is thrombus formation.If the thrombi leave the left atrium, they enter the aorta (main artery) via the left ventricle and continue on their way to the brain (sleep apnea) into the arms or legs (peripheral arterial occlusion) or into the intestinal arteries (mesenteric infarction). If the thrombi leave the right atrium, they enter the lung via the right heart, through the pulmonary artery and cause a pulmonary embolism. It is therefore very important to perform anticoagulation in atrial fibrillation. Here too, the INR should be between 2-3.
Marcumar® after surgery
The effect of Marcumar® is very difficult to control and can only be counteracted with foreign coagulation factors or with vitamin K. Marcumar® must therefore be discontinued before an operation. After the operation, heparin should be injected instead of Marcumar® for about seven days to prevent any insatiable bleeding after the operation. After the seven days, therapy with Marcumar® can be continued. During the first 72 hours, heparin should be injected parallel to the reapplied therapy with Marcumar®, as the effect of Marcumar® does not set in until 72 hours after the first dose. After 72 hours, heparin can be discontinued, but an INR control should be performed.
Taking Marcumar® after heparin
Heparin is also an anticoagulant drug (anticoagulant). Heparin has a much shorter duration of action than Marcumar®. It is therefore easier to control.
In addition, there is a drug (antidote) for heparin that cancels out the effect of heparin. The drug is protamine. When treating with heparin, dosing with Marcumar® can be started in parallel.
After three days, the heparin should be discontinued and the INR should be checked. Marcumar® can be replaced with heparin at any time. However, if the product is well tolerated, Marcumar® should be restarted in the long term and should be the therapy of choice.
