Pharmacogenetics of warfarin dosing in patients of African and European ancestry.

Pharmacogenomics 2018 11 22;19(17):1357-1371. Epub 2018 Oct 22.

Department of Neurology, School of Medicine, University of Alabama at Birmingham, AL 35294, USA.

Despite the introduction of direct acting oral anticoagulants, warfarin remains the most commonly prescribed oral anticoagulant. However, warfarin therapy is plagued by the large inter- and intrapatient variability. The variability in dosing fueled research to identify clinical and genetic predictors and develop more accurate dosing algorithms. Observational studies have demonstrated the significant impact of single nucleotide polymorphisms in CYP2C9 and VKORC1 on warfarin dose in patients of European ancestry and African-Americans. This evidence supported the design and conduct of clinical trials to assess whether genotype-guided dosing results in improved anticoagulation control and outcomes. The trial results have shown discordance by race, with pharmacogenetic algorithms improving dose and anticoagulation control among European ancestry patients compared with African-American patients. Herein, we review the evidence from observational and interventional studies, highlight the need for inclusion of minority race groups and propose the need to develop race specific dosing algorithms.

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http://dx.doi.org/10.2217/pgs-2018-0146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6562764PMC
November 2018
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References

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Aust. Fam. Physician 2010

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