Warfarin (Coumafene) 是一种维生素 K 拮抗剂,它通过阻断维生素 K 的作用而起作用,维生素 K 是肝脏中凝血因子合成所必需的。Warfarin 通过抑制γ -谷氨酰羧化酶来阻断维生素 K 的作用,γ -谷氨酰羧化酶负责凝血因子中谷氨酸残基的羧化。这阻止了功能性凝血因子的产生,从而产生抗凝作用。
Dehydro warfarin is a metabolite of (±)-warfarin .1It is formed from (±)-warfarin by rat liver microsomes. 1.Kaminsky, L.S., Fasco, M.J., and Guengerich, F.P.Comparison of different forms of liver, kidney, and lung microsomal cytochrome P-450 by immunological inhibition of regio- and stereoselective metabolism of warfarinJ. Biol. Chem.254(19)9657-9662(1979)
10-hydroxy Warfarin is a metabolite of (R)-warfarin .1It is formed from (R)-warfarin by the cytochrome P450 (CYP) isoform CYP3A4. 10-hydroxy Warfarin is an inhibitor of CYP2C9 (IC50= 1.6 μM), the enzyme that converts (S)-warfarin to its 6-hydroxy warfarin and 7-hydroxy warfarin metabolites.2 1.Kaminsky, L.S., and Zhang, Z.-Y.Human P450 metabolism of warfarinPharmacol. Ther.73(1)67-74(1997) 2.Jones, D.R., Kim, S.-Y., Guderyon, M., et al.Hydroxywarfarin metabolites potently inhibit CYP2C9 metabolism of S-warfarinChem. Res. Toxicol.23(5)939-945(2010)
Acenocoumarol is a short-lived oral anti-coagulant, which, like warfarin, functions by inhibiting vitamin K epoxide reductase. It has higher intrinsic anticoagulant potency than warfarin and phenprocoumon, when evaluated in vitro. Acenocoumarol has a single chiral center that gives rise to two different enantiomeric forms. (S)-Acenocoumarol has a shorter plasma elimination half-life (1.8 hours) and faster plasma clearance (28.5 L hour), compared to the (R)-enantiomer (6.6 hours, 1.9 L hour). The S-enantiomer undergoes extensive first-pass metabolism during absorption from the gastrointestinal tract, whereas (R)-acenocoumarol is rapidly absorbed and provides essentially complete oral bioavailability. Perhaps related to these pharmacokinetic characteristics, (S)-acenocoumarol is less potent in vivo as an anti-coagulant than the (R)-enantiomer. As the clearance of acenocoumarol is ~20-fold faster than that for warfarin, the plasma concentrations of acenocoumarol are substantially lower than those for warfarin in patients receiving long-term treatment.