Experience of individualization of oral anticoagulants use and dosage in personalized medicine centre conditions
- Authors: Rumyantsev NA1, Sychev DA2, Kukes VG1,3, Kazakov RE3, Rumyantsev AA4, Taratuta TV1
-
Affiliations:
- I.M. Sechenov First Moscow State Medical University, Moscow, Russia
- Russian Medical Academy of Post-Graduate Education, Moscow, Russia
- Scientific Center of Medical Facilities Expertise of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
- N.N.Blokhin Memorial Cancer-Research Center, Moscow, Russia
- Issue: Vol 96, No 6 (2015)
- Pages: 1065-1068
- Section: Assistance to the practicing physician
- URL: https://journals.rcsi.science/kazanmedj/article/view/1642
- DOI: https://doi.org/10.17750/KMJ2015-1065
- ID: 1642
Cite item
Full Text
Abstract
The application of pharmacogenetic testing was analyzed in patients treated at the center of personalized medicine, in order to analyze gene polymorphism frequency - response predictors to indirect anticoagulants therapy, estimation of the warfarin dose selection time, the hospitalization duration. The presence of VKORC1 and CYP2C9 polymorphisms or homozygous polymorphisms combinations is quite common in the Russian population: CYP2C9*2 polymorphism (15.3%) was observed in 8 patients, CYP2C9*3 (9.6%) in 5 patients. VKORC1 gene A allele was detected in 18 patients, accounting for 34.6% of the whole group. In patients with this polymorphism warfarin administration according to the traditional algorithm often leads to excessive anticoagulation and bleeding. Initiation of warfarin therapy according to the scheme taking into account genotyping significantly increases the treatment safety and reduces the adverse events incidence in this group of patients.
Keywords
About the authors
N A Rumyantsev
I.M. Sechenov First Moscow State Medical University, Moscow, Russia
Author for correspondence.
Email: elmed@yandex.ru
D A Sychev
Russian Medical Academy of Post-Graduate Education, Moscow, Russia
Email: elmed@yandex.ru
V G Kukes
I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Scientific Center of Medical Facilities Expertise of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
Email: elmed@yandex.ru
R E Kazakov
Scientific Center of Medical Facilities Expertise of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
Email: elmed@yandex.ru
A A Rumyantsev
N.N.Blokhin Memorial Cancer-Research Center, Moscow, Russia
Email: elmed@yandex.ru
T V Taratuta
I.M. Sechenov First Moscow State Medical University, Moscow, Russia
Email: elmed@yandex.ru
References
- Драпкина О.М., Чернова Е.М. Миопатия как побочный эффект терапии статинами: механизмы развития и перспективы лечения. Рационал. фармакотерап. в кардиол. 2005; 11: 96-101.
- Козлова Т.В. Контроль за лечением оральными антикоагулянтами. Фарматека. 2003; 3: 87-92.
- Козлова Т.В. Эффективность и безопасность длительной антикоагулянтной терапии варфарином у больных с венозными тромбозами. Науч.-практ. ревматол. 2005; 4: 53-57.
- Кукес В.Г., Грачёв С.В., Сычёв Д.А., Раменская Г.В. Метаболизм лекарственных средств: научные основы персонализированной медицины. М.: ГЭОТАР- Медиа. 2008; 304 с.
- Сычёв Д.А., Антонов И.М., Загребин С.В. Алгоритмы дозирования варфарина, основанные на результатах фармакогенетического тестирования: реальная возможность оптимизации фармакотерапии. Рационал. фармакотерап. в кардиол. 2007; 2: 59-66.
- Сычёв Д.А., Сулейманов С.Ш., Кукес В.Г. Персонализированная медицина как путь к рациональному применению лекарственных средств: предпосылки, реалии, проблемы и перспективы для отечественной системы здравоохранения. Здравоохр. Дальн. Востока. 2010; 1: 2-7.
- Румянцев Н.А., Сычёв Д.А., Кукес В.Г. Перспективы индивидуализации применения и дозирования пероральных антикоагулянтов и статинов у пациентов в рутинной клинической практике. Клин. фармакол. и терап. 2015; 24: в печати.
- Dowlatshahi D., Butcher K.S., Asdaghi N. et al. Poor prognosis in warfarin-associated intracranial hemorrhage despite anticoagulation reversal. Stroke. 2012; 43: 1812-1817. http://dx.doi.org/10.1161/STROKEAHA.112.652065
- Herman D., Locatelli I., Grabnar I. et al. Influence of CYP2C9 polymorphisms, demographic factors and concomitant drug therapy on warfarin metabolism and maintenance dose. J. Pharmacogenomics. Inpress. 2005; 5: 193-202.
- Link E., Parish S., Armitage J. et al. SEARCH Collaborative Group. SLCO1B1 variants and statin-induced myopathy a genomewide study. New Engl. J. Med. 2008; 359 (8): 789-799. http://dx.doi.org/10.1056/NEJMoa0801936
- Mhairi C. Oral Anticoagulation and Hemorrhagic Complications in an Elderly Population With Atrial Fibrillation. Arch. Intern. Med. 2001; 161: 2125-2128. http://dx.doi.org/10.1001/archinte.161.17.2125
- Marini C., De Santis F., Sacco S. et al. Contribution of atrial fibrillation to incidence and outcome of ischemic stroke: results from a population_based study. Stroke. 2005; 36: 1115-1159. http://dx.doi.org/10.1161/01.STR.0000166053.83476.4a