10 years of oral anticoagulant pharmacogenomics: What difference will it make? A critical appraisal

Daniel Kurnik*, Ronen Loebstein, Hillel Halkin, Eva Gak, Shlomo Almog

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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.

Original languageEnglish
Pages (from-to)1955-1965
Number of pages11
JournalPharmacogenomics
Volume10
Issue number12
DOIs
StatePublished - 2009

Keywords

  • CYP2C9
  • Dosing algorithm
  • Oral anticoagulants
  • Personalized medicine
  • Pharmacogenetics
  • Pharmacogenomics
  • VKORC1
  • Warfarin

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