title: Can pharmacogenetics help patients under chronic treatment with coumarin anticoagulants?
abstract: Vitamin K antagonists are highly effective antithrombotic drugs. However, appropriate dosing is difficult to establish owing to its narrow therapeutic window as well as widespread inter- and intra-individual variability in dosage. Compared with dosing solely based on clinical information, pharmacogenetics can help improve the therapy with coumarins by decreasing the time to reach a stable dose and reducing the risk of bleeding. Most of the studies about genotyping of patients using vitamin K antagonists have focused on predicting the stable dose. Two genes have been shown to have the most influence on dosing: VKORC1 and CYP2C9. Furthermore, genotyping of more genes, such as CYP4F2 and APOE, is also being included in some dosing algorithms. The role of genotype beyond the initial dose-titration phase is less clear. Thus, a proven genetically determined risk of unstable dose or bleeding could help with the selection of patients who require more frequent monitoring of dose. On the other hand, patients who have a genetically determined stable dose could self-monitor their international normalized ratio (INR), making the therapy less expensive and more convenient.
authors.forename: Isabel
authors.initials: I
authors.lastname: López
authors.forename: Estela
authors.initials: E
authors.lastname: Sangüesa
authors.forename: Yves
authors.initials: Y
authors.lastname: Vancraenendonck
authors.forename: Estefanía
authors.initials: E
authors.lastname: Zuriaga
authors.forename: María Pilar
authors.initials: MP
authors.lastname: Ribate
authors.forename: Cristina Belén
authors.initials: CB
authors.lastname: García
mesh_terms: D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D003374:Coumarins / Q000008:administration & dosage / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005838:Genotype; D006801:Humans; D010597:Pharmacogenetics; D014812:Vitamin K / Q000037:antagonists & inhibitors*
chemical_list: D000925:Anticoagulants; D003374:Coumarins; D014812:Vitamin K; C030123:coumarin