Identification of environmental and genetic factors that influence warfarin time in therapeutic range.
Mariana R BottonPatrícia P ViolaMariana R MeirelesEstela M BruxelPriccila ZuchinaliEliane BandinelliLuis E RohdeTiago L L LeiriaJoyce Y Y SalamoniArthur P GarbinMara Helena HutzPublished in: Genetics and molecular biology (2020)
Warfarin is an oral anticoagulant prescribed to prevent and treat thromboembolic disorders. It has a narrow therapeutic window and must have its effect controlled. Prothrombin test, expressed in INR value, is used for dose management. Time in therapeutic range (TTR) is an important outcome of quality control of anticoagulation therapy and is influenced by several factors. The aim of this study was to identify genetic, demographic, and clinical factors that can potentially influence TTR. In total,422 patients using warfarin were investigated. Glibenclamide co-medication and presence of CYP2C9*2 and/or *3 alleles were associated with higher TTR, while amiodarone, acetaminophen and verapamil co-medication were associated with lower TTR. Our data suggest that TTR is influenced by co-medication and genetic factors. Thus, individuals in use of glibenclamide may need a more careful monitoring and genetic testing (CYP2C9*2 and/or *3 alleles) may improve the anticoagulation management. In addition, in order to reach and maintain the INR in the target for a longer period, it is better to discuss dose adjustment in office instead of by telephone assessment. Other studies are needed to confirm these results and to find more variables that could contribute to this important parameter.
Keyphrases
- atrial fibrillation
- venous thromboembolism
- direct oral anticoagulants
- quality control
- genome wide
- healthcare
- end stage renal disease
- copy number
- chronic kidney disease
- newly diagnosed
- ejection fraction
- emergency department
- electronic health record
- dna methylation
- stem cells
- gene expression
- bone marrow
- climate change
- deep learning
- single molecule