Scientists from Saudi Arabia designed a study in order to determine the effect of Cytochrome P450 2C9 controlled by an oxidizing gene (CYP2C9) on therapeutic efficiency of an anticoagulant drug i.e. Warafin. They found that CYP2C9 polymorphism affects warfarin dosage and efficiency among a subset of Saudi population and tends to be a good clinical practice mainly in patients experiencing excessive bleeding or patients with less time in therapeutic range1.
Personalized medicines are being the future medicine trend2. Personalized therapies can give many insights about optimal patient care as most coagulation disorders and vitamin K antagonists (VKA) being implied may have several unfavorable events3. Individualization of therapy based on patient’s genetic profile is particularly important with certain drugs.
Warfarin is one of vitamin K antagonists (VKA) that is extensively utilized anticoagulant with inter and intra-individual dosage variability depending on many non-genetic and genetic factors. Therefore scientists study the effect of cytochrome P450 2C9 isoform (CYP2C9) polymorphism on the dosage variability and therapeutic efficacy of warfarin in a subset of Saudi patient.
Scientists selected 112 patients for the study. They were already on regular warfarin therapy for numerous reasons. Patients incorporated were part of the regular care provided to all other patients who did not participate in the study. Genomic DNA was isolated and then quantified for all the patients. The DNA samples were genotyped by method of TaqMan allelic discrimination genotyping for CYP2C9*2 and CYP2C9*3 alleles. The prime result was time in therapeutic range (TTR).
Researchers basically wanted to explore the impact of CYP2C9 allelic variant on warfarin dose constraint in a rift of Saudi patients and found that the presence of *2 and *3 heterozygous alleles predict lower warfarin dose requirement and lower time in therapeutic range (TTR). Additionally, the presence of CYP2C9 *2/*2 homozygous alleles require administration of a very low weekly warfarin dose.
Authors of study conclusively said that:
“It is crucial for all anticoagulation clinics to establish a reliable monitoring system (database) in order to keep track of difficult patients or patients that spend less TTR. Healthcare workers of anticoagulation clinic should consider such database and continuously review it. Such practice will be extremely beneficial for patient safety and better overall care.”
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17 November, 2019