Q: I underwent aortic valve replacement surgery at AIIMS almost 14 years back. Since then I am on Acitrom therapy. I have a mechanical valve. I came to Canada last year and the doctors here are not familiar with Acitrom so are suggesting to use Coumadin as an anticoagulant. But I had enough stock of Acitrom with me and I am continuously taking it. Last week my INR jumped to 4.7 (taking 4.00 mg dose daily) so the doctor advised to stop medicines for 2 days. Now I am again taking 2 mg & 4 mg alternate days and INR is still to be checked. Here it takes 3 days for the results. Are the salts in both the drugs the same? Are there any side effects of Acitrom in the long run?

A:Acitrom is the brand name of a medicine called nicoumalone. Coumadin contains warfarin. Both nicoumalone and warfarin are quite similar and belong to the coumarin group of drugs. In Canada and UK, nicoumalone (sold under the brand names of Sintrom and Sinthrome) is widely used while in USA, warfarin is in vogue. You can use any one of the two agents.