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The Pharmacogenetics of Vitamin K Antagonist Anticoagulation Drugs

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Pharmacogenomic Testing in Current Clinical Practice

Part of the book series: Molecular and Translational Medicine ((MOLEMED))

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Abstract

Since the first report on warfarin pharmacogenetics in 1999, genetic ­variants have emerged as an important predictor of warfarin maintenance doses before therapy is initiated, raising expectations of greatly improved clinical outcomes. However, much of the information on warfarin sensitivity conveyed by genetic variants is captured by early international normalized ratio values traditionally used to guide dose titration. Thus, inclusion of early international normalized ratios in prediction models reduces the contribution of genetics. Moreover, in large population cohorts, genetics explained only 20–30% of variance in warfarin doses. Finally, even pharmacogenetic prediction models did not predict doses reliably in the majority of at-risk patients with warfarin requirements at the low or high end of the dose range. Currently, the clinical utility and cost–effectiveness of pharmacogenetic – based dosing are being assessed in large prospective trials in various settings. In the interim, enthusiasm for warfarin pharmacogenetics should not supersede strict adherence to traditional measures used to optimize coumarin anticoagulation.

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  1. Washington University in St. Louis, 660 South Euclid Avenue, St. Louis, MO, 63110, USA

    Charles Eby

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  1. San Francisco General Hospital, Clinical Chemistry Lab., University of California, San Francisco, 1001 Potrero Ave., San Francisco, 94110, California, USA

    Alan H. B. Wu

  2. Department of Pathology, Clinical Pharmacogenomics Program, University of Chicago, S. Maryland Ave. 5841, Chicago, 60637, Illinois, USA

    Kiang-Teck J. Yeo

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Eby, C. (2011). The Pharmacogenetics of Vitamin K Antagonist Anticoagulation Drugs. In: Wu, A., Yeo, KT. (eds) Pharmacogenomic Testing in Current Clinical Practice. Molecular and Translational Medicine. Humana Press. https://doi.org/10.1007/978-1-60761-283-4_8

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