title: Warfarin pharmacogenomics in children.
abstract: Warfarin is the most commonly used oral anticoagulant worldwide. Warfarin has a narrow therapeutic index, requiring frequent monitoring of the INR to achieve therapeutic anticoagulation. The role of pharmacogenomics in warfarin disposition and response has been well established in adults, but remains unclear for pediatric patients. In this review, we focus on the important CYP2C9 and VKORC1 variants involved in warfarin response, our current understanding of warfarin disposition and pharmacogenomics, and recent warfarin pharmacogenetic studies in pediatric patients. Finally, we discuss the need for future pediatric studies and the clinical implications of developing pharmacogenetic-based dosing algorithms in children.
authors.affiliation: Pediatric Heme/Onc, Vanderbilt University/Monroe Carell Jr Children's Hospital, Nashville, Tennessee, USA.
authors.forename: Susan I
authors.initials: SI
authors.lastname: Vear
authors.forename: C Michael
authors.initials: CM
authors.lastname: Stein
authors.forename: Richard H
authors.initials: RH
authors.lastname: Ho
mesh_terms: D000293:Adolescent; D000328:Adult; D000465:Algorithms; D000925:Anticoagulants / Q000493:pharmacokinetics* / Q000627:therapeutic use; D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D065729:Cytochrome P-450 CYP2C9; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D006899:Mixed Function Oxygenases / Q000235:genetics / Q000378:metabolism; D010597:Pharmacogenetics / Q000379:methods* / Q000639:trends; D064417:Vitamin K Epoxide Reductases; D014859:Warfarin / Q000493:pharmacokinetics* / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D006899:Mixed Function Oxygenases; C450260:CYP2C9 protein, human; D065729:Cytochrome P-450 CYP2C9; D001189:Aryl Hydrocarbon Hydroxylases; C578523:VKORC1 protein, human; D064417:Vitamin K Epoxide Reductases
keywords: CYP2C9; VKORC1; pharmacogenomics; warfarin