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1.
Transfus Med ; 21(4): 280-4, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21733006
2.
PLoS One ; 8(8): e71505, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23990957

RESUMO

BACKGROUND AND AIM: Warfarin is the most frequently prescribed anticoagulant worldwide. However, warfarin therapy is associated with a high risk of bleeding and thromboembolic events because of a large interindividual dose-response variability. We investigated the effect of genetic and non genetic factors on warfarin dosage in a South Italian population in the attempt to setup an algorithm easily applicable in the clinical practice. MATERIALS AND METHODS: A total of 266 patients from Southern Italy affected by cardiovascular diseases were enrolled and their clinical and anamnestic data recorded. All patients were genotyped for CYP2C9 2, 3, CYP4F2 3, VKORC1 -1639 G>A by the TaqMan assay and for variants VKORC1 1173 C>T and VKORC1 3730 G>A by denaturing high performance liquid chromatography and direct sequencing. The effect of genetic and not genetic factors on warfarin dose variability was tested by multiple linear regression analysis, and an algorithm based on our data was established and then validated by the Jackknife procedure. RESULTS: Warfarin dose variability was influenced, in decreasing order, by VKORC1-1639 G>A (29.7%), CYP2C9 3 (11.8%), age (8.5%), CYP2C9 2 (3.5%), gender (2.0%) and lastly CYP4F2 3 (1.7%); VKORC1 1173 C>T and VKORC1 3730 G>A exerted a slight effect (<1% each). Taken together, these factors accounted for 58.4% of the warfarin dose variability in our population. Data obtained with our algorithm significantly correlated with those predicted by the two online algorithms: Warfarin dosing and Pharmgkb (p<0.001; R(2) = 0.805 and p<0.001; R(2) = 0.773, respectively). CONCLUSIONS: Our algorithm, which is based on six polymorphisms, age and gender, is user-friendly and its application in clinical practice could improve the personalized management of patients undergoing warfarin therapy.


Assuntos
Anticoagulantes/administração & dosagem , Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/genética , Esquema de Medicação , Farmacogenética/métodos , Varfarina/administração & dosagem , Idoso , Algoritmos , Alelos , Hidrocarboneto de Aril Hidroxilases/genética , Cromatografia Líquida de Alta Pressão , Citocromo P-450 CYP2C9 , Sistema Enzimático do Citocromo P-450/genética , Família 4 do Citocromo P450 , Relação Dose-Resposta a Droga , Feminino , Genótipo , Humanos , Coeficiente Internacional Normatizado , Itália , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Análise de Regressão , Vitamina K Epóxido Redutases/genética
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