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Chaidaroglou A, Kanellopoulou T, Panopoulos G, Stavridis G, Degiannis D. Extremely low therapeutic doses of acenocoumarol in a patient with CYP2C9*3/*3 and VKORC1-1639A/A genotype. Pharmacogenomics 2019; 20:311-317. [DOI: 10.2217/pgs-2018-0189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Vitamin-K antagonists (VKAs) have remained the mainstay of oral anticoagulant therapy for the treatment and prevention of thromboembolism. The management of treatment with VKAs is challenging due to their narrow therapeutic index and the wide interindividual variation in response to therapy. Variants of the CYP2C9 and the VKORC1 gene account for 30–50% of the variability in dosing requirements, and it has been proposed that genotyping of these loci could facilitate management of VKA therapy and minimize risk of overanticoagulation, even in very low doses. We present the first reported case of a patient with the compounded genotype CYP2C9*3*3 and VKORC1-1639A/A under treatment with acenocoumarol, and review of other reported cases with analogous genotypic profiles but under treatment with warfarin.
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Affiliation(s)
- Antigoni Chaidaroglou
- Molecular Immunopathology & Histocompatibility Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | - Theoni Kanellopoulou
- Department of Clinical Hematology, Blood Bank & Hemostasis, Onassis Cardiac Surgery Center, Athens, Greece
| | | | - George Stavridis
- Third Department of Cardiac Surgery, Onassis Cardiac Surgery Center, Athens, Greece
| | - Dimitrios Degiannis
- Molecular Immunopathology & Histocompatibility Unit, Onassis Cardiac Surgery Center, Athens, Greece
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Dimitrova-Karamfilova A, Tzveova R, Chilingirova N, Goranova T, Nachev G, Mitev V, Kaneva R. Acenocoumarol Pharmacogenetic Dosing Algorithms and Their Application in Two Bulgarian Patients with Low Anticoagulant Requirements. Biochem Genet 2015; 53:334-50. [PMID: 26377995 DOI: 10.1007/s10528-015-9695-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 09/05/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND The anticoagulant therapy with acenocoumarol is generally associated with a high risk of bleeding and thromboembolic events. PURPOSE We applied eight already existing acenocoumarol dosing algorithms to Bulgarian patients with low acenocoumarol dose requirements and investigated which of these algorithms would predict most precisely the dose anticoagulant. MATERIALS AND METHODS Two patients with Bulgarian origin were referred to the outpatient clinical laboratory of "St. Ekaterina" University Hospital for Cardiovascular Surgery and Cardiology, Sofia, Bulgaria. After obtaining written informed consent, both patients were genotyped for polymorphisms in genes for Cytochrome P450 2C9 (CYP2C9), Vitamin K epoxide reductase (VKORC1), Apolipoprotein E (APOE), and Cytochrome P450 4F2 (CYP4F2). RESULTS All applied acenocoumarol dosing algorithms predicted relatively similar doses of coumarin anticoagulant in both patients. However, van Schie et al.'s algorithm allowed more accurate calculation of the optimal dose in our patients with extremely low acenocoumarol requirements. Genotyping of selected polymorphic variants in CYP2C9 and VKORC1 showed that both patients were compound heterozygotes for CYP2C9 (CYP2C9*2/*3) and homozygotes for both variants in VKORC1 (VKORC1 1173 T/T, and VKORC1-1639 A/A). This combination of genotypes suggested high sensitivity to acenocoumarol leading to the low anticoagulant dose requirements (0.25 and 1 mg/day, respectively) needed to reach the target International Normalized Ratio of 2.5-3.5. CONCLUSIONS The genotyping of polymorphic variants in VKORC1 and CYP2C9, together with clinical and demographic parameters, can serve for more precise definition of the individual starting and maintenance doses of coumarin derivatives in each patient.
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Affiliation(s)
- Antoaneta Dimitrova-Karamfilova
- Department of Clinical Laboratory, University Hospital of Cardiovascular Surgery and Cardiology "St. Ekaterina"- Sofia, 52A Pencho Slaveykov bul., 1431, Sofia, Bulgaria
| | - Reni Tzveova
- Molecular Medicine Center, Department of Medical Chemistry and Biochemistry, Medical Faculty, Medical University - Sofia, 2 Zdrave str, 1431, Sofia, Bulgaria.
| | - Nezabravka Chilingirova
- Department of Clinical Laboratory, University Hospital of Cardiovascular Surgery and Cardiology "St. Ekaterina"- Sofia, 52A Pencho Slaveykov bul., 1431, Sofia, Bulgaria
| | - Teodora Goranova
- Molecular Medicine Center, Department of Medical Chemistry and Biochemistry, Medical Faculty, Medical University - Sofia, 2 Zdrave str, 1431, Sofia, Bulgaria
| | - Gencho Nachev
- Department of Cardiovascular Surgery, University Hospital of Cardiovascular Surgery and Cardiology "St. Ekaterina"- Sofia, 52A Pencho Slaveykov bul., 1431, Sofia, Bulgaria
| | - Vanio Mitev
- Molecular Medicine Center, Department of Medical Chemistry and Biochemistry, Medical Faculty, Medical University - Sofia, 2 Zdrave str, 1431, Sofia, Bulgaria
| | - Radka Kaneva
- Molecular Medicine Center, Department of Medical Chemistry and Biochemistry, Medical Faculty, Medical University - Sofia, 2 Zdrave str, 1431, Sofia, Bulgaria
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Tzveova R, Dimitrova-Karamfilova A, Saraeva R, Solarova T, Naydenova G, Petrova I, Hristova N, Popov I, Nachev G, Mitev V, Kaneva R. Estimation and validation of acenocoumarol dosing algorithms in Bulgarian patients with cardiovascular diseases. Per Med 2015; 12:209-220. [PMID: 29771648 DOI: 10.2217/pme.14.80] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aim & Methods: A total of 169 Bulgarian patients were genotyped for CYP2C9*2,*3, VKORC1-1639G>A and VKORC11173C>T. The effect of genetic and nongenetic factors on acenocoumarol dose variability was tested in a derivation cohort of patients and the obtained algorithm was validated in a test cohort. RESULTS & DISCUSSION It was found that VKORC-1639G>A (25.5%), CYP2C9*2 (7.8%), CYP2C9*3 (6.1%), age (13.6%) and diagnosis (6.0%) significantly affected acenocoumarol dose variability in the derivation cohort. These factors with additional factors, such as sex (0.1%, p = 0.76), weight (2.6%, p = 0.14) and amiodarone use (3.0%, p = 0.059) accounted for 46.5% and 23.0% of the dose variability for genetic and clinical models, respectively. CONCLUSION Based on the results of this investigation, validated clinical and pharmacogenetic algorithms for the prediction of a stable anticoagulant dose were developed, specifically designed for the Bulgarian population.
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Affiliation(s)
- Reni Tzveova
- Molecular Medicine Center, Department of Medical Chemistry & Biochemistry, Medical Faculty, Medical University - Sofia, 2 Zdrave str, Sofia 1431, Bulgaria
| | - Antoaneta Dimitrova-Karamfilova
- Department of Clinical Laboratory, University National Multi-profile Active Treatment Hospital "St. Ekaterina"- Sofia, 52A Pencho Slaveykov bul., Sofia 1431, Bulgaria
| | - Radoslava Saraeva
- Molecular Medicine Center, Department of Medical Chemistry & Biochemistry, Medical Faculty, Medical University - Sofia, 2 Zdrave str, Sofia 1431, Bulgaria
| | - Tanya Solarova
- Department of Clinical Laboratory, University National Multi-profile Active Treatment Hospital "St. Ekaterina"- Sofia, 52A Pencho Slaveykov bul., Sofia 1431, Bulgaria
| | - Galya Naydenova
- Second Department of Cardiology, University NationalMulti-profile Active Treatment Hospital "Dr. G. Stansky"- Pleven, 8A Georgi Kochev str., Pleven 5800, Bulgaria
| | - Irina Petrova
- Department of Clinical Laboratory, University National Multi-profile Active Treatment Hospital "St. Ekaterina"- Sofia, 52A Pencho Slaveykov bul., Sofia 1431, Bulgaria
| | - Nataliya Hristova
- Department of Clinical Laboratory, University National Multi-profile Active Treatment Hospital "St. Ekaterina"- Sofia, 52A Pencho Slaveykov bul., Sofia 1431, Bulgaria
| | - Ivan Popov
- Molecular Medicine Center, Department of Medical Chemistry & Biochemistry, Medical Faculty, Medical University - Sofia, 2 Zdrave str, Sofia 1431, Bulgaria
| | - Gencho Nachev
- Department of Cardiac Surgery, University National Multi-profile Active Treatment Hospital "St. Ekaterina"- Sofia, 52A Pencho Slaveykov bul., Sofia 1431, Bulgaria
| | - Vanio Mitev
- Molecular Medicine Center, Department of Medical Chemistry & Biochemistry, Medical Faculty, Medical University - Sofia, 2 Zdrave str, Sofia 1431, Bulgaria
| | - Radka Kaneva
- Molecular Medicine Center, Department of Medical Chemistry & Biochemistry, Medical Faculty, Medical University - Sofia, 2 Zdrave str, Sofia 1431, Bulgaria
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Krishna Kumar D, Madhan S, Balachander J, Sai Chandran B, Thamijarassy B, Adithan C. Effect of CYP2C9 and VKORC1 genetic polymorphisms on mean daily maintenance dose of acenocoumarol in South Indian patients. Thromb Res 2013; 131:363-7. [DOI: 10.1016/j.thromres.2013.02.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 02/06/2013] [Accepted: 02/11/2013] [Indexed: 01/03/2023]
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Mazur-Bialy AI, Zdebska K, Wypasek E, Undas A. Repeated bleeding complications during therapy with vitamin K antagonists in a patient with the VKORC1*2A and the CYP2C9*3/*3 alleles: genetic testing to support switching to new oral anticoagulants. Thromb Res 2013; 131:279-80. [PMID: 23276529 DOI: 10.1016/j.thromres.2012.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 12/07/2012] [Accepted: 12/10/2012] [Indexed: 10/27/2022]
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