Genetic Variations and Warfarin Dosing

Abstract

Warfarin is an anticoagulant that acts as a blood thinner. It is a coumarin derivative and works as an anticoagulant by interfering with vitamin K and its 2,3 epoxide's cyclic interconversion. It is frequently employed to prevent blood clots like deep vein thrombosis and pulmonary embolism, for stroke, in patients with atrial fibrillation, valvular heart disease, or prosthetic heart valves. Establishing warfarin dosing is hard since it has been shown to interact with a variety of drugs and foods and is especially affected by the genetic make-up of the patients. In this review, we surveyed the literature for genes that are implicated in the pharmacology of Warfarin. We discussed studies showing the association of different variants of these gens and the dose of Warfarin. Our investigations reveal several genes including VKORC1, CYP2C9, CYP2F4, ORM1, ABCB1, CYP4F2, APOE, PROC, GGCX, EPHX1, CALU, MYH6, SETD1A, and their variants are being studied extensively by the researchers. However, most significant associations of warfarin dosing have been found with genetic variants in the VKORC1 and CYP2C9 genes. Our review corroborates the previous studies that recommend that an algorithm consisting of different genetic variants based on their relative effect on warfarin pharmacology be further refined and tested in large clinical trials.