title: CYP2C9*3 polymorphism presenting as lethal subdural hematoma with low-dose warfarin.
abstract: Warfarin is the most common and cheap oral anticoagulant currently used in clinical practice. A high inter-individual variation is seen in the response to warfarin. Recently, pharmacogenetics has gained importance in managing patients on warfarin, both in predicting the optimum required dose as well as in decreasing the risk of bleeding. This case report is a description of a 49-year-old patient who had a lethal subdural hematoma with low-dose warfarin. He was subsequently found to have CYP2C9 gene polymorphism (*1/*3). This case report stresses the importance of pre-prescription assessment of genetic analysis for those initiated on warfarin.
authors.affiliation: Department of Medicine, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, India.
authors.forename: Niteen D
authors.initials: ND
authors.lastname: Karnik
authors.affiliation: Department of Pharmacology, Subharti Medical College, Meerut, Uttar Pradesh, India.
authors.forename: Kannan
authors.initials: K
authors.lastname: Sridharan
authors.affiliation: Department of Medicine, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, India.
authors.forename: D
authors.initials: D
authors.lastname: Tiwari
authors.affiliation: Department of Medicine, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Parel, Mumbai, Maharashtra, India.
authors.forename: V
authors.initials: V
authors.lastname: Gupta
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D065729:Cytochrome P-450 CYP2C9 / Q000235:genetics*; D004305:Dose-Response Relationship, Drug; D006408:Hematoma, Subdural / Q000139:chemically induced* / Q000235:genetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010597:Pharmacogenetics; D011110:Polymorphism, Genetic; D014859:Warfarin / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D065729:Cytochrome P-450 CYP2C9
keywords: CYP2C9; oral anticoagulant; pharmacogenetics; warfarin