Modern warfarin- dosing algorithms in patients with atrial fibrillation

Authors

  • M. Yu. Kolesnyk Zaporizhzhia State Medical University,
  • Ya. M. Mykhaylovskyi Zaporizhzhia State Medical University,

DOI:

https://doi.org/10.14739/2310-1210.2015.6.57033

Keywords:

Atrial Fibrillation, Warfarin, Therapeutics, Pharmacogenetics, Genetic Testing

Abstract

Aim. Thromboembolic complications are the leading cause of mortality in patients with atrial fibrillation. In order to summarize and represent a modern view on the anticoagulation therapy with warfarin recent specialized literature was reviewed. It was found that warfarin therapy is characterized by some difficulties in applying that limit the frequency of its appointment in patients with atrial fibrillation. It was found that the metabolism of warfarin is influenced by many factors, among which important role is given to genetic factors.

Conclusions. It is shown that the traditional empirical approach to the warfarin dosing has a number of disadvantages associated with variability in pharmacokinetics, necessity to constant monitor its anticoagulant effect and a high risk of bleeding. Personalized approach of warfarin dosing based on pharmacogenetic testing is promising.

 

References

Tseluyko, V., Motyilevskaya, T., Martsovenko, I., & Opolonskaya, N. (2011). Profilaktika tromboembolicheskogo insulta pri fibrillyatsii predserdiy: standartyi i realnost [Prevention of thromboembolic stroke in patients with atrial fibrillation: standards and reality]. Ukrayins'kyy Kardiolohichnyy Zhurnal, (1), 7-12.

January, C., Wann, L., Alpert, J., Calkins, H., Cigarroa, J., & Cleveland, J. et al. (2014). 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation, 130(23), 2071-2104.

Sulimov, V., Golitsyin, S., Panchenko, E., Popov S.V., Revishvili, A., Shubik, Y., & Yavelov, I. (2014). Diagnostika i lechenie fibrillyatsii predserdiy. Rekomendatsii RKO, VNOA i ASSH [Diagnosis and treatment of atrial fibrillation. Recommendations of RSC, RSSC and ACS]. Rossiyskiy Kardiologicheskiy Zhurnal, 4(102), the appendix 3, 1-144.

Guyatt, G. (2012). Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines. Chest, 141(2_suppl), 53S.

Tseluyko, V., & Opolonskaya, N. (2013). Rasprostranennost faktorov riska tromboembolicheskih i gemorragicheskih oslozhneniy sredi bolnyih s fibrillyatsiey predserdiy [The prevalence of risk factors for thromboembolic and bleeding complications in patients with atrial fibrillation]. Meditsina neotlozhnyih sostoyaniy, (7), 65-69.

Assotsiatsiya kardiologov Ukrainyi, & Assotsiatsiya aritmologov Ukrainyi,. (2011). Diagnostika i lechenie fibrillyatsii predserdiy [Diagnostics and treatment of atrial fibrillation]. (2011). Kiev, 1-159.

Hart, R. (2007). Meta-analysis: Antithrombotic Therapy to Prevent Stroke in Patients Who Have Nonvalvular Atrial Fibrillation. Annals Of Internal Medicine, 146(12), 857.

Eikelboom, J., Hirsh, J., Spencer, F., Baglin, T., & Weitz, J. (2012). Antiplatelet Drugs. Chest,141(2_suppl), e89S.

Gavrisjuk E.V., Sychev D.A., Ignat'ev I.V. et al. (2012) Problems of organization indirect anticoagulants therapy on an outpatient basis. Vestnik Roszdravnadzora. (1): 28–33.

Dzyak, G., Vasileva, L., & Nikolaenko-Kamyishova, T. (2009). Antikoagulyantyi nepryamogo deystviya v kardiologii: pokazaniya i protivopokazaniya, dozirovanie i oslozhneniya [Anticoagulants of indirect action in cardiology: indications and contraindications, dosage and complications]. Liky Ukrayiny, 7(133), 117-119.

Gilyarov, M., Generozov, E., Magomadova, M., Moroshkina, S., Sarkisova, Pogoda, T., Sarkisova, N., Sulimov, V., & Syirkin, A. (2008). Faktoryi, vliyayuschie na dozirovku varfarina u patsientov s fibrillyatsiey predserdiy [Factors affecting the dose of warfarin in patients with atrial fibrillation]. Kardiologiya I Serdechno-Sosudistaya Hirurgiya, 1(5), 65-68.

Syichev, D., Antonov, I., Zagrebin, S., Gasanov, N., & Kukes, V. (2007). Algoritmyi dozirovaniya varfarina, osnovannyie na rezultatah farmakogeneticheskogo testirovaniya: realnaya vozmozhnost optimizatsii farmakoterapii [Warfarin dosing algorithm based on the results of pharmacogenetic testing: a real opportunity to optimize pharmacotherapy]. Ratsionalnaya Farmakoterapiya V Kardiologii, (2), 59-66.

Holbrook, A. (2005). Systematic Overview of Warfarin and Its Drug and Food Interactions. Arch Intern Med, 165(10), 1095.

Fang, M., Go, A., Chang, Y., Borowsky, L., Pomernacki, N., Udaltsova, N., & Singer, D. (2011). A New Risk Scheme to Predict Warfarin-Associated Hemorrhage. Journal Of The American College Of Cardiology, 58(4), 395-401.

Artanova, E. (2012). Kontrol za antikoagulyantnoy terapiey i kachestvo zhizni bolnyih s fibrillyatsiey predserdiy [Monitoring of anticoagulant therapy and quality of life of patients with atrial fibrillation]. Saratovskiy Nauchno-Meditsinskiy Zhurnal, 8(2), 258-264.

Cleland, J., Findlay, I., Jafri, S., Sutton, G., Falk, R., & Bulpitt, C. et al. (2004). The Warfarin/Aspirin study in heart failure (WASH): a randomized trial comparing antithrombotic strategies for patients with heart failure. American Heart Journal, 148(1), 157-164.

Lip, G., & Edwards, S. (2006). Stroke prevention with aspirin, warfarin and ximelagatran in patients with non-valvular atrial fibrillation: A systematic review and meta-analysis. Thrombosis Research,118(3), 321-333.

Gage, B. (2006). Pharmacogenetics-Based Coumarin Therapy. Hematology, 2006(1), 467-473.

Buzoianu, A., Trifa, A., Mureşanu, D., & Crişan, S. (2012). Analysis of CYP2C9*2 , CYP2C9*3 and VKORC1 -1639 G>A polymorphisms in a population from South-Eastern Europe. J. Cell. Mol. Med., 16(12), 2919-2924.

Rusdiana, T., Araki, T., Nakamura, T., Subarnas, A., & Yamamoto, K. (2012). Responsiveness to low-dose warfarin associated with genetic variants of VKORC1, CYP2C9, CYP2C19, and CYP4F2 in an Indonesian population. European Journal Of Clinical Pharmacology, 69(3), 395-405.

Sconce, E. (2005). The impact of CYP2C9 & VKORC1 genetic polymorphism and patient characteristics upon warfarin dose requirements: proposal for a new dosing regimen. Blood, 106(7), 2329-2333.

Johnson, J., Gong, L., Whirl-Carrillo, M., Gage, B., Scott, S., &

Stein, C. et al. (2011). Clinical Pharmacogenetics Implementation Consortium Guidelines for CYP2C9 and VKORC1 Genotypes and Warfarin Dosing. Clin Pharmacol Ther, 90(4), 625-629.

Teh, L., Langmia, I., Fazleen Haslinda, M., Ngow, H., Roziah, M., Harun, R., Zakaria, Z. & Salleh, M. (2011). Clinical relevance of VKORC1 (G-1639A and C1173T) and CYP2C9*3 among patients on warfarin. Journal of Clinical Pharmacy and Therapeutics, 37(2), 232-236.

Zhu, Y., Shennan, M., Reynolds, K., Johnson, N., Herrnberger, M., Valdes, R. & Linder, M. (2007). Estimation of Warfarin Maintenance Dose Based on VKORC1 (-1639 G>A) and CYP2C9 Genotypes. Clinical Chemistry, 53(7), 1199-1205.

Epstein, R., Moyer, T., Aubert, R., OKane, D., Xia, F., Verbrugge, R., Gage, B. & Teagarden, J. (2010). Warfarin Genotyping Reduces Hospitalization Rates. Journal of the American College of Cardiology, 55(25), 2804-2812.

Kropacheva E.S. (2015). Byistryie tempyi nasyischeniya varfarinom - prediktor razvitiya chrezmernoy gipokoagulyatsii. Modernizatsiya algoritma podbora dozyi varfarina [The rapid pace of saturation of warfarin - a predictor of excessive anticoagulation. Modernization algorithm dose adjustment of warfarin]. Aterotromboz, (1), 75-86.

Sullivan, P., Arant, T., Ellis, S. & Ulrich, H. (2006). The Cost Effectiveness of Anticoagulation Management Services for Patients with Atrial Fibrillation and at High Risk of Stroke in the US. PharmacoEconomics, 24(10), 1021-1033.

Sanderson, S., Emery, J. & Higgins, J. (2005). CYP2C9 gene variants, drug dose, and bleeding risk in warfarin-treated patients: A HuGEnet™ systematic review and meta-analysis. Genetics in Medicine, 7(2), 97-104.

Syichev D. A. (2011). Rekomendatsii po primeneniyu farmakogeneticheskogo testirovaniya v klinicheskoy praktike. Kachestvennaya klinicheskaya praktika [Recommendations for the use of pharmacogenetic testing in clinical practice]. Kachestvennaya Klinicheskaya Praktika, 1, 4-10.

Antonov I.M. (2010). Antikoagulyantnyie kliniki: zarubezhnyiy opyit i perspektivyi dlya Rossiyskogo zdravoohraneniya [Anticoagulant clinic: international experience and prospects for the Russian Health]. Kreativnaya Kardiologiya, 1, 35-41.

Epstein, R., Moyer, T., Aubert, R., Kane, D., Xia, F., Verbrugge, R., Gage, B. & Teagarden, J. (2010). Warfarin Genotyping Reduces Hospitalization Rates. Journal of the American College of Cardiology, 55(25), 2804-2812.

Gavrisyuk, E., Syichev, D., Kazakov, R., Kossovskaya, A. & Marinin, V. (2015). Opyit ispolzovaniya farmakogeneticheskogo testirovaniya dlya personalizatsii dozirovaniya varfarina v poliklinicheskih usloviyah [Experience of pharmacogenetic testing using for warfarin dosing personalizing in outpatient conditions]. Tihookeanskiy meditsinskiy zhurnal, (1), 60-62.

Daly, A. (2013). Optimal dosing of warfarin and other coumarin anticoagulants: the role of genetic polymorphisms. Archives of Toxicology, 87(3), 407-420.

Syichev D. A. (2007). Algoritmyi dozirovaniya varfarina, osnovannyie na rezultatah farmakogeneticheskogo testirovaniya: realnaya vozmozhnost optimizatsii farmakoterapii [Warfarin dosing algorithm based on the results of pharmacogenetic testing: a real opportunity to optimize pharmacotherapy]. Ratsionalnaya Farmakoterapiya v Kardiologii, 2, 59-66.

How to Cite

1.
Kolesnyk MY, Mykhaylovskyi YM. Modern warfarin- dosing algorithms in patients with atrial fibrillation. Zaporozhye Medical Journal [Internet]. 2015Dec.29 [cited 2024Oct.16];17(6). Available from: http://zmj.zsmu.edu.ua/article/view/57033