Pharmacogenetics of Oral Anticoagulants

The use of oral anticoagulants (OA) is problematic due to its association with hemorrhagic complications. OA metabolism relies on the CYP2C9 complex. Genetic variations compromising metabolic competence of this complex may explain the risk of excessive and hazardous anticoagulation. A pharmacogenetics-based approach to this issue could be beneficial for choosing adequate dose and duration of treatment, in addition to having a better understanding of pharmacological interactions to which OA are susceptible. However, evidence from several basic and clinical studies indicates that both a complicated system of regulation of expression of multiple genes and the influence of a wide variety of epigenetic factors could be responsible for adverse drug reactions associated with the use of OA. Emphasis on understanding the gene-environment interactions could attain new paths to facilitate the use of these important drugs in the quotidian clinical practice.