Pharmacogenetic-guided Dosing of Coumarin Anticoagulants: Algorithms for Warfarin, Acenocoumarol and Phenprocoumon

Overview

Journal Br J Clin Pharmacol

Specialty Pharmacology

Date 2013 Aug 8

PMID 23919835

Citations 45

Authors

Talitha I Verhoef

William K Redekop

Ann K Daly

Rianne M F van Schie

Anthonius de Boer

Anke-Hilse Maitland-van der Zee

Affiliations

Soon will be listed here.

Abstract

Coumarin derivatives, such as warfarin, acenocoumarol and phenprocoumon are frequently prescribed oral anticoagulants to treat and prevent thromboembolism. Because there is a large inter-individual and intra-individual variability in dose-response and a small therapeutic window, treatment with coumarin derivatives is challenging. Certain polymorphisms in CYP2C9 and VKORC1 are associated with lower dose requirements and a higher risk of bleeding. In this review we describe the use of different coumarin derivatives, pharmacokinetic characteristics of these drugs and differences amongst the coumarins. We also describe the current clinical challenges and the role of pharmacogenetic factors. These genetic factors are used to develop dosing algorithms and can be used to predict the right coumarin dose. The effectiveness of this new dosing strategy is currently being investigated in clinical trials.

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