Warfarin Anticoagulant Therapy: A Southern Italy Pharmacogenetics-Based Dosing Model

Cristina Mazzaccara, Valeria Conti, Rosario Liguori, Vittorio Simeon, Mario Toriello, Angelo Severini, Corrado Perricone, Alfonso Meccariello, Pasquale Meccariello, Dino Franco Vitale, Amelia Filippelli, Lucia Sacchetti

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Background and Aim:Warfarin is the most frequently prescribed anticoagulant worldwide. However, warfarin therapy is associated with a high risk of bleeding and thromboembolic events because of a large interindividual dose-response variability. We investigated the effect of genetic and non genetic factors on warfarin dosage in a South Italian population in the attempt to setup an algorithm easily applicable in the clinical practice.Materials and Methods:A total of 266 patients from Southern Italy affected by cardiovascular diseases were enrolled and their clinical and anamnestic data recorded. All patients were genotyped for CYP2C9*2,*3, CYP4F2*3, VKORC1 -1639 G>A by the TaqMan assay and for variants VKORC1 1173 C>T and VKORC1 3730 G>A by denaturing high performance liquid chromatography and direct sequencing. The effect of genetic and not genetic factors on warfarin dose variability was tested by multiple linear regression analysis, and an algorithm based on our data was established and then validated by the Jackknife procedure.Results:Warfarin dose variability was influenced, in decreasing order, by VKORC1-1639 G>A (29.7%), CYP2C9*3 (11.8%), age (8.5%), CYP2C9*2 (3.5%), gender (2.0%) and lastly CYP4F2*3 (1.7%); VKORC1 1173 C>T and VKORC1 3730 G>A exerted a slight effect (2 = 0.805 and p2 = 0.773, respectively).Conclusions:Our algorithm, which is based on six polymorphisms, age and gender, is user-friendly and its application in clinical practice could improve the personalized management of patients undergoing warfarin therapy.

Original languageEnglish
Article numbere71505
JournalPLoS One
Issue number8
Publication statusPublished - Aug 26 2013

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

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    Mazzaccara, C., Conti, V., Liguori, R., Simeon, V., Toriello, M., Severini, A., Perricone, C., Meccariello, A., Meccariello, P., Vitale, D. F., Filippelli, A., & Sacchetti, L. (2013). Warfarin Anticoagulant Therapy: A Southern Italy Pharmacogenetics-Based Dosing Model. PLoS One, 8(8), [e71505]. https://doi.org/10.1371/journal.pone.0071505