Genotype-guided warfarin therapy: current status

Pharmacogenomics. 2018 May;19(7):667-685. doi: 10.2217/pgs-2017-0207. Epub 2018 Apr 27.

Abstract

Warfarin pharmacogenomics has been an extensively studied field in the last decades as it is focused on personalized therapy to overcome the wide interpatient warfarin response variability and decrease the risk of side effects. In this expert review, besides briefly summarizing the current knowledge about warfarin pharmacogenetics, we also present an overview of recent studies that aimed to assess the efficacy, safety and economic issues related to genotype-based dosing algorithms used to guide warfarin therapy, including randomized and controlled clinical trials, meta-analyses and cost-effectiveness studies. To date, the findings still present disparities, mostly because of standard limitations. Thus, further studies should be encouraged to try to demonstrate the benefits of the application of warfarin pharmacogenomic dosing algorithms in clinical practice.

Keywords: genotype-guided dosing algorithms; pharmacogenetic-based algorithm; pharmacogenetics; polymorphisms; vitamin k antagonist; warfarin.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Algorithms
  • Anticoagulants* / administration & dosage
  • Anticoagulants* / pharmacokinetics
  • Anticoagulants* / therapeutic use
  • Biomarkers, Pharmacological
  • Cytochrome P-450 Enzyme System / genetics
  • Dose-Response Relationship, Drug
  • Humans
  • Pharmacogenetics*
  • Pharmacogenomic Testing
  • Polymorphism, Single Nucleotide
  • Precision Medicine*
  • Vitamin K Epoxide Reductases / genetics
  • Warfarin* / administration & dosage
  • Warfarin* / pharmacokinetics
  • Warfarin* / therapeutic use

Substances

  • Anticoagulants
  • Biomarkers, Pharmacological
  • Warfarin
  • Cytochrome P-450 Enzyme System
  • VKORC1 protein, human
  • Vitamin K Epoxide Reductases