title: Oral anticoagulation: a critique of recent advances and controversies.
abstract: There have recently been significant advances in the field of oral anticoagulation, but these have also led to many controversies. Warfarin is still the commonest drug used for clotting disorders but its use is complicated owing to wide inter-individual variability in dose requirement and its narrow therapeutic index. Warfarin dose requirement can be influenced by both genetic and environmental factors. Two recent randomized controlled trials (RCTs) came to different conclusion regarding the utility of genotype-guided dosing; we critically explore the reasons for the differences. The new generation of oral anticoagulants have been demonstrated to be as efficacious as warfarin, but further work is needed to evaluate their safety in real clinical settings.
authors.affiliation: The University of Liverpool, Liverpool L69 3BX, UK; Royal Liverpool and Broadgreen University Hospital National Health Service (NHS) Trust, Prescot Street, Liverpool L7 8XP, UK. Electronic address: munirp@liverpool.ac.uk.
authors.forename: Munir
authors.initials: M
authors.lastname: Pirmohamed
authors.affiliation: Newcastle University, Newcastle upon Tyne NE2 4HH, UK.
authors.forename: Farhad
authors.initials: F
authors.lastname: Kamali
authors.affiliation: Newcastle University, Newcastle upon Tyne NE2 4HH, UK.
authors.forename: Ann K
authors.initials: AK
authors.lastname: Daly
authors.affiliation: Uppsala University, 751 85 Uppsala, Sweden.
authors.forename: Mia
authors.initials: M
authors.lastname: Wadelius
mesh_terms: D000284:Administration, Oral; D000465:Algorithms; D000925:Anticoagulants / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D005838:Genotype; D006801:Humans; D014812:Vitamin K / Q000037:antagonists & inhibitors; D014859:Warfarin / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014812:Vitamin K; D014859:Warfarin
keywords: algorithm; oral anticoagulant; pharmacogenomics; vitamin K antagonist; warfarin