“…If this VKORC1 mutationinduced mechanism can be excluded in the case of the natural resistance to VKA of females, differences in the expression level of genes encoding putative partner proteins of VKORC1, such as calumenin (Wallin et al, 2001), epoxide hydrolase (Guenthner et al, 1998) or glutathione transferase (Cain et al, 1998), could modify this VKOR activity. Other mechanisms could be suspected to explain the better tolerance of females to VKA, such the existence of metabolic differences between males and females (Huber et al, 1999;Markussen et al, 2007Markussen et al, , 2008Mugford and Kedderis, 1998;Waxman, 1988), or even a natural resistance of the coagulation cascade (Lemini et al, 2007) after VKA administration.…”