- Title
- Issues of pharmacogenomics in monitoring warfarin therapy
- Creator
- Martin, Jennifer; Somogyi, Andrew
- Relation
- Clinical Challenges in Therapeutic Drug Monitoring: Special Populations, Physiological Conditions and Pharmacogenomics p. 261-277
- Relation
- https://www.elsevier.com/books/clinical-challenges-in-therapeutic-drug-monitoring/clarke/978-0-12-802025-8
- Publisher
- Elsevier
- Resource Type
- book chapter
- Date
- 2016
- Description
- Warfarin is a very widely used therapy worldwide, despite newer oral anticoagulants that have become available in some countries during approximately the past 5 years. The reasons for the lower than expected uptake of the newer agents may include cost, excess bleeding risk with dabigatran or need for monitoring in some patients, lack of reversibility for several new anticoagulants, and the high cost of these reversal agents where they exist. The fact that new agents have not been embraced as widely as predicted may suggest that warfarin will remain the mainstay of oral anticoagulant therapy for the near future. Thus, there remains a need to continue research to dose warfarin more safely and effectively. The main complaint with warfarin is the large inter- and intrapatient variability noted in warfarin dosage requirements. Although some variability is related to factors such as gender and age, a large amount of variability is not accounted for; this is likely related to factors such as components of diet, concomitant therapies, and an individual's bowel flora. To facilitate dosing, a number of algorithms have been made available to support warfarin use. However, such algorithms have usually been unable to take into account possible genetic factors that may contribute to pharmacokinetics and pharmacodynamics of warfarin therapy, thus eventually helping in predicting an individual's loading and maintenance doses for safer anticoagulation. This chapter discusses the factors known to affect therapeutic anticoagulation with warfarin, including the pharmacogenetic polymorphisms in CYP2C9 and genetic polymorphisms in the C1 subunit of the vitamin K 2,3-epoxide reductase complex.
- Subject
- pharmacogenomics; warfarin; warfarin therapy; anticoagulation medication
- Identifier
- http://hdl.handle.net/1959.13/1340624
- Identifier
- uon:28531
- Identifier
- ISBN:9780128020258
- Language
- eng
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