The Pharmacogenetics of Vitamin K Antagonist Anticoagulation Drugs

Eby, Charles S.

doi:10.1007/978-1-60761-283-4_8

Cited by 2 publications

(2 citation statements)

References 92 publications

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“…Potential sources of missing information include additional genetic variation, epigenetic factors, additional drug-drug interactions, and patient behaviors, including diet, exercise, and compliance. 64 Future pharmacogenetic studies that are able to control for environmental factors may reveal additional genetic variants implicated in warfarin dosing.…”

Section: Future Directionsmentioning

confidence: 99%

Clinical Practice Recommendations on Genetic Testing of CYP2C9 and VKORC1 Variants in Warfarin Therapy

Shaw

Amstutz

Kim

et al. 2015

Therapeutic Drug Monitoring

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Objective: To systematically review evidence on genetic variants influencing outcomes during warfarin therapy and provide practice recommendations addressing the key questions: (1) Should genetic testing be performed in patients with an indication for warfarin therapy to improve achievement of stable anticoagulation and reduce adverse effects? (2) Are there subgroups of patients who may benefit more from genetic testing compared with others? (3) How should patients with an indication for warfarin therapy be managed based on their genetic test results?Methods: A systematic literature search was performed for VKORC1 and CYP2C9 and their association with warfarin therapy. Evidence was critically appraised, and clinical practice recommendations were developed based on expert group consensus.Results: Testing of VKORC1 (21639G.A), CYP2C9*2, and CYP2C9*3 should be considered for all patients, including pediatric patients, within the first 2 weeks of therapy or after a bleeding event. Testing for CYP2C9*5, *6, *8, or *11 and CYP4F2 (V433M) is currently not recommended. Testing should also be considered for all patients who are at increased risk of bleeding complications, who consistently show out-of-range international normalized ratios, or suffer adverse events while receiving warfarin. Genotyping results should be interpreted using a pharmacogenetic dosing algorithm to estimate the required dose.Significance: This review provides the latest update on genetic markers for warfarin therapy, clinical practice recommendations as a basis for informed decision making regarding the use of genotypeguided dosing in patients with an indication for warfarin therapy, and identifies knowledge gaps to guide future research.

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Section: Future Directionsmentioning

confidence: 99%

Clinical Practice Recommendations on Genetic Testing of CYP2C9 and VKORC1 Variants in Warfarin Therapy

Shaw

Amstutz

Kim

et al. 2015

Therapeutic Drug Monitoring

View full text Add to dashboard Cite

show abstract

“…Genetic variants can be explained part of dose variability, such as variants of the CYP2C9, VKORC1, CYP4F2 genes. Some epigenetic factors, additional drug-drug interactions, patient behaviors, including diet, exercise and compliance are also potential sources (2). Patients on long-term warfarin therapy have a risk of 1%~3% per year for haemorrhage leading to hospitalization or death (3,4), which is the most worrying adverse events of warfarin.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Pharmacist-led Anticoagulation Management on Clinical Outcomes: A Systematic Review and Meta-Analysis

Hou

Yang

et al. 2017

J Pharm Pharm Sci

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-OBJECTIVES:We performed this systematic review and meta-analysis to confirm whether patients benefit more from pharmacist-led anticoagulation management than other models. METHODS: We searched PubMed, Embase, Cochrane Library and reference lists of yielded results conducted up to April 25, 2017. RCTs and observational cohort studies and case-control studies which compared the percentage of time within the target therapeutic range (TTR), the percentage of time within the expanded therapeutic range (TER), haemorrhage events, thrombosis events, mortality, patient satisfaction and/or medicine cost saving of pharmacist-led anticoagulation management with other models, and species were limited to humans. Two investigators evaluated methodology and extracted data from included studies independently. Data analysis were performed by STATA 12.0 software and quality of evidence assessment was performed by GRADEprofiler software. RESULTS: 8 RCTs and 9 observational cohort studies with 9919 patients were included eventually with high quality and no publication bias. In RCTs pooled results, TTR (p=0.548 moderate-quality), TER (p=0.285, moderate-quality), total haemorrhage events (p=0.140, low-quality), minor haemorrhage events (p=0.162, low-quality), major haemorrhage events (p=0.237, low-quality), thrombosis events (p=0.615, low-quality) and mortality (p=0.876, low-quality) was not significant between two groups.

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The Pharmacogenetics of Vitamin K Antagonist Anticoagulation Drugs

Cited by 2 publications

References 92 publications

Clinical Practice Recommendations on Genetic Testing of CYP2C9 and VKORC1 Variants in Warfarin Therapy

Clinical Practice Recommendations on Genetic Testing of CYP2C9 and VKORC1 Variants in Warfarin Therapy

Effectiveness of Pharmacist-led Anticoagulation Management on Clinical Outcomes: A Systematic Review and Meta-Analysis

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