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Koshy L, Vb R, M M, Ben MP, Kishor P, Sudhakaran PR, Abdullakutty J, Venugopal K, Zachariah G, Mohanan PP, Harikrishnan S, G S. Pharmacogenetic variants influence vitamin K anticoagulant dosing in patients with mechanical prosthetic heart valves. Pharmacogenomics 2022; 23:475-485. [PMID: 35608144 DOI: 10.2217/pgs-2022-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Vitamin K antagonists (VKAs) are class I oral anticoagulants that are widely prescribed following surgical heart valve implantation. The objective of this study was to quantify the relative effects of VKORC1, CYP2C9 and CYP4F2 genotypes in predicting VKA dosing. Materials & methods: A total of 506 South Indian patients with mechanical prosthetic heart valves who were prescribed oral VKAs, such as warfarin or acenocoumarol, were genotyped. The discriminatory ability of mutant genotypes to predict dose categories and bleeding events was assessed using regression analysis. Results: The VKORC1 rs9923231, CYP2C9*3 and CYP4F2*3 mutant genotypes significantly influenced VKA-dose requirements and explained 27.47% of the observed dose variation. Conclusion: These results support pharmacogenetic screening for initial VKA dosing among South Indian patients with mechanical prosthetic heart valves.
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Affiliation(s)
- Linda Koshy
- Centre for Advanced Research & Excellence in Heart Failure, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, 695011, India
| | - Raghu Vb
- Inter-University Centre for Genomics & Gene Technology, Department of Biotechnology, University of Kerala, Trivandrum, Kerala, 695581, India
| | - Madhuma M
- Centre for Advanced Research & Excellence in Heart Failure, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, 695011, India
| | - Midhuna P Ben
- Inter-University Centre for Genomics & Gene Technology, Department of Biotechnology, University of Kerala, Trivandrum, Kerala, 695581, India
| | - Pritam Kishor
- Integrated Science Education & Research Centre, Visva-Bharati, Santineketan, West Bengal, 731235, India
| | - P R Sudhakaran
- Inter-University Centre for Genomics & Gene Technology, Department of Biotechnology, University of Kerala, Trivandrum, Kerala, 695581, India
| | | | - K Venugopal
- Department of Cardiology, Pushpagiri Hospital, Thiruvalla, Pathanamthitta, Kerala, 689101, India
| | - Geevar Zachariah
- Department of Cardiology, Mother Hospital, Thrissur, Kerala, 680012, India
| | - P P Mohanan
- Department of Cardiology, Westfort Hi-Tech Hospital, Thrissur, Kerala, 680002, India
| | - S Harikrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, 695011, India
| | - Sanjay G
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, 695011, India
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Colet C, Botton MR, Schwambach KH, Amador TA, Heineck I. Polymorphism of the CYP2C9 and VKORC1 genes in patients on the public health system of a municipality in Southern Brazil. J Vasc Bras 2021; 20:e20200214. [PMID: 34104133 PMCID: PMC8166164 DOI: 10.1590/1677-5449.200214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Genetic factors can be responsible for part of the populational and interindividual differences observed in warfarin users. Objectives To identify occurrence of polymorphisms of the CYP2C9 and VKORC1 genes in patients taking warfarin and relate these profiles to their medication dosages and the Time in Therapeutic Range (TTR). Methods Monthly interviews were conducted for data collection. Data were collected on demographic characteristics and medications in use, especially warfarin, including reason for prescription and weekly dose. TTR was calculated as the percentage of days with international normalized ratio (INR) between 2 and 3. The CYP2C9 and VKORC1 genes were analyzed at a Human Genetics Laboratory. Results 49 patients (74.2%) had polymorphisms of the CYP2C9 and/or VKORC1 genes; the remaining 17 (25.8%) did not have these polymorphisms. The average weekly dose of warfarin was lower among those who had a polymorphism for any of the genes compared to those who did not, with a significant difference (p = 0.035). The mean TTR was also lower among patients with polymorphism. However, the difference between the two groups was not significant for this variable (p = 0.438). Conclusions An association was observed between the polymorphisms and the warfarin doses taken by the patients. However, there was no association with adverse events or the time spent within the therapeutic range in this sample.
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Affiliation(s)
- Christiane Colet
- Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, RS, Brasil.,Universidade Regional do Noroeste do Estado do Rio Grande do Sul - UNIJUÍ, Ijuí, RS, Brasil
| | - Mariana Rodrigues Botton
- Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, RS, Brasil.,Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brasil
| | - Karin Hepp Schwambach
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brasil
| | - Tânia Alves Amador
- Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, RS, Brasil
| | - Isabela Heineck
- Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, RS, Brasil
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Akdeniz CS, Cevik M, Canbolat IP, Yurdakul S, Cagatay P, Ciftci C, Karaalp A, Susleyici B. The effects of CYP2C9 and VKORC1 gene polymorphisms on warfarin maintenance dose in Turkish cardiac patients. Future Cardiol 2020; 16:645-654. [PMID: 32583677 DOI: 10.2217/fca-2020-0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Our aim was to examine the effect of CYP2C9 and VKORC1 polymorphisms on warfarin dose requirements in Turkish patients. Materials & methods: 24 warfarin prescribed patients were included and analyzed for eight VKORC1 and 6 CYP2C9 polymorphisms in the study. Results: Patients with CYP2C9 *1/*1 and VKORC1 -1639 GG and GA genotypes required higher warfarin doses in comparison to wild type VKORC1 genotype. Patients with CYP2C9 *1/*3 and VKORC1 -1639 GG genotypes simultaneously, required the lowest dose of warfarin (4.64 mg/day). Patients with CYP2C9 *1/*1 and VKORC1 9041 AA genotype were found to require higher warfarin doses. Conclusion: Our results provide additional evidence to support the hypothesis that CYP2C9 *2, *3, VKORC1 9041 G > A polymorphisms explain considerable proportion of inter-individual variability in warfarin dose requirement.
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Affiliation(s)
- Cansu Selcan Akdeniz
- Department of Cardiology, Demiroglu Bilim University Faculty of Medicine, Istanbul, Turkey
| | - Mehtap Cevik
- Department of Molecular Biology, Marmara University Faculty of Science & Letters, Istanbul, Turkey
| | - Ismail Polat Canbolat
- Department of Cardiology, Demiroglu Bilim University Faculty of Medicine, Istanbul, Turkey
| | - Selen Yurdakul
- Department of Cardiology, Demiroglu Bilim University Faculty of Medicine, Istanbul, Turkey
| | - Penbe Cagatay
- Vocational School of Health Service, Department of Medical Services & Technics, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Cavlan Ciftci
- Department of Cardiology, Demiroglu Bilim University Faculty of Medicine, Istanbul, Turkey
| | - Atila Karaalp
- Department of Medical Pharmacology, Marmara University School of Medicine, Istanbul, Turkey
| | - Belgin Susleyici
- Department of Molecular Biology, Marmara University Faculty of Science & Letters, Istanbul, Turkey
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Harikrishnan S, Koshy L, Subramanian R, Sanjay G, Vineeth CP, Nair AJ, Nair GM, Sudhakaran PR. Value of VKORC1 (-1639G>A) rs9923231 genotyping in predicting warfarin dose: A replication study in South Indian population. Indian Heart J 2018; 70 Suppl 3:S110-S115. [PMID: 30595241 PMCID: PMC6310074 DOI: 10.1016/j.ihj.2018.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/25/2018] [Accepted: 07/09/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Warfarin is the most commonly prescribed oral anticoagulant, although having a narrow therapeutic index and wide interindividual variability. The aim of this study was to replicate the utility of VKORC1 (-1639G>A) rs9923231 genotyping in predicting the mean daily dose and to evaluate its ability to categorize warfarin-treated patients to high-, intermediate-, or low-dose categories in the South Indian population. MATERIALS AND METHODS A cohort of 222 warfarin-treated patients was genotyped using restriction fragment length polymorphism method. The influence of the rs9923231 polymorphism on the variations in the mean daily dose was compared using one-way analysis of variance and linear regression analysis. Discriminatory ability of the rs9923231 polymorphism to group the patients into ordered dose categories was assessed by estimating the proportional odds ratios using the ordered logit regression analysis. RESULTS The frequency of AA genotype and A allele in the study sample was found to be 1.8% and 9.23%, respectively, which was similar to reports from other South Indian populations. The mean daily dose required to achieve the optimum international normalized ratio was significantly lower in AA homozygous genotype carriers (3.99 ± 1.67 mg/day) and GA heterozygous (4.26 ± 1.57 mg/day) compared to the GG genotype carriers (5.51 ± 2.13 mg/day), p = 0.003. The A allele carriers (GA+AA genotypes) had a 3.23 higher odds of being grouped as a low-dose requiring category compared to non-carriers (95% CI 1.49-6.98, p = 0.003). CONCLUSIONS These preliminary results strongly support the use of VKORC1 (-1639G>A) rs9923231 polymorphism for genetically guided initial warfarin dosing in South Indian patients with heart valve replacements.
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Affiliation(s)
- S Harikrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695 011, Kerala, India.
| | - Linda Koshy
- Inter-University Centre for Genomics and Gene Technology, Department of Biotechnology, University of Kerala, Trivandrum, 695 581, Kerala, India.
| | - Ram Subramanian
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695 011, Kerala, India.
| | - G Sanjay
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695 011, Kerala, India.
| | - C P Vineeth
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, 695 011, Kerala, India.
| | - A Jayakumaran Nair
- Inter-University Centre for Genomics and Gene Technology, Department of Biotechnology, University of Kerala, Trivandrum, 695 581, Kerala, India.
| | - G M Nair
- Inter-University Centre for Genomics and Gene Technology, Department of Biotechnology, University of Kerala, Trivandrum, 695 581, Kerala, India.
| | - P R Sudhakaran
- Inter-University Centre for Genomics and Gene Technology, Department of Biotechnology, University of Kerala, Trivandrum, 695 581, Kerala, India.
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