Oral Anticoagulant Therapy-When Art Meets Science.
Patricia Lorena CîmpanChira Romeo IoanMihaela MocanFlorin Petru AntonAnca Daniela FarcaşPublished in: Journal of clinical medicine (2019)
Anticoagulant treatment is extremely important and frequently encountered in the therapy of various cardiovascular diseases. Vitamin K antagonists (VKA) are in use for the prevention and treatment of arterial and venous thromboembolism, despite the introduction of new direct-acting oral anticoagulants (NOAC). The VKA still have the clear recommendation in patients with a mechanical prosthetic heart valve replacement or moderate to severe mitral stenosis of the rheumatic origin, in deep vein thrombosis associated with congenital thrombophilia, and in cases where NOAC are prohibited by social condition (financial reason) or by comorbidities (extreme weight, severe renal or liver disease). VKA dosing required to reach the targeted therapeutic range varies largely between patients (inter-individual variability). This inter-individual variability depends on multiple environmental factors such as age, mass, diet, etc. but it is also influenced by genetic determinism. About 30 genes implicated in the metabolism coumarins derivatives were identified, the most important being CYP2C9 and VKORC, each with several polymorphisms. Herein, we review the data regarding genetic alterations in general and specific populations, highlight the diagnosis options in particular cases presenting with genetic alteration causing higher sensitivity and/or resistance to VKA therapy and underline the utility of NOAC in solving such rare and difficult problems.
Keyphrases
- oral anticoagulants
- atrial fibrillation
- venous thromboembolism
- genome wide
- mitral valve
- cardiovascular disease
- direct oral anticoagulants
- end stage renal disease
- mental health
- physical activity
- left atrial
- copy number
- weight loss
- heart failure
- ejection fraction
- type diabetes
- rheumatoid arthritis
- newly diagnosed
- early onset
- chronic kidney disease
- aortic stenosis
- public health
- electronic health record
- left ventricular
- prognostic factors
- combination therapy
- catheter ablation
- drug delivery
- antiretroviral therapy
- transcription factor
- deep learning
- health insurance
- genetic diversity
- patient reported
- affordable care act