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<meta name="keywords" content="C0750384, coumadin response, coumarin resistance, coumarin sensitivity, coumarin, poor metabolism of, cyp2a6, cyp2a6, v1, cyp2c9, finding, vkorc1, warfarin resistance, warfarin response, warfarin sensitivity, autosomal dominant, autosomal recessive, birth defects, chromosomal disease, chromosome, clinical features, clinical findings, clinical genetics, clinical recommendations, clinvar, congenital chromosomal disease, consumer genetic resources, cytogenetic location, disease characteristics, disease definitions, disease descriptions, disease ontology, disease synonyms, disease vocabulary, dysmorphology, entrez, familial disease, gene, gene-disease relationship, genereviews, genetic disease, genetic disorder, genetic terminology, genetic testing registry, genetics home reference, genomic disease, gtr, hereditary disease, heritable disease, hpo, human phenotype ontology, inherited disease, management guidelines, maternal inheritance, medgen, medical genetics, medical subject headings, mesh, mitochondrial inheritance, mode of inheritance, national center for biotechnology information, national institutes of health, national library of medicine, ncbi, nih, nlm, omim, ordo, orphanet, paternal inheritance, phenome, position statements, professional practice guidelines, rare disease, reference sequence, refseq, snomed ct, syndrome, undiagnosed diseases, x-linked recessive" /><meta name="description" content="Warfarin is an oral anti-coagulant used world-wide to treat and prevent thrombotic disorders. While it is highly effective, it has a very narrow therapeutic index making it difficult to dose correctly. Genetic variants in cytochrome P450-2C9 (CYP2C9), vitamin K-epoxide reductase complex (VKORC1), cytochrome P450-CYP4F2 (CYP4F2) and the CYP2C cluster (eg. rs12777823), along with non-genetic factors, are known to affect warfarin dose variability. Patients with specific variants in the gene CYP2C9 (the primary warfarin-metabolizing enzyme) may require a lower dose of warfarin as compared to patients without these variants. Patients with specific variants in VKORC1 (the target enzyme of warfarin) may require a lower warfarin dose as compared to patients who do not have these variants. The combination of CYP2C9/VKORC1/CYP4F2/CYP2C genetic variants, along with clinical factors, can put some patients at risk for therapeutic failure or adverse events such as bleeding. Guidelines regarding the use of pharmacogenomic tests in dosing for warfarin have been published in Clinical Pharmacology and Therapeutics by the Clinical Pharmacogenetics Implementation Consortium (CPIC) and are available on the CPIC and PharmGKB websites." /><meta name="robots" content="index,nofollow,noarchive" />
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<!--
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UID=148193
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ConceptID=C0750384
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-->
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<!--imgCountBooks = 0--><h1 class="medgenTitle"><div class="MedGenTitleText">Warfarin response</div></h1><div class="aux"><div class="resc"><dl class="rprtid"><dt>MedGen UID: </dt><dd>148193</dd><dt><span class="dotprefix"> •</span>Concept ID: </dt><dd><a href="/medgen/docs/help/#sources" target="_blank" title="Concept Unique Identifier from NLM's Unified Medical Language system (UMLS) Click for more information."><span class="highlight" style="background-color:">C0750384</span></a></dd><dt><span class="dotprefix"> •</span></dt><dd>Finding</dd></dl></div></div><table class="medgenTable"><tbody><tr><td>Synonyms:</td>
|
||
<td>Coumadin response; Coumarin resistance; COUMARIN SENSITIVITY; COUMARIN, POOR METABOLISM OF; Cyp2a6, v1; WARFARIN RESISTANCE; Warfarin sensitivity</td></tr>
|
||
<tr><td>Drug:</td>
|
||
<td>
|
||
<div class="divPopper rprt" id="drug_22695"><div><strong>Warfarin</strong><div class="aux"><div class="resc"><dl class="rprtid"><dt>MedGen UID: </dt><dd>22695</dd><dt><span class="dotprefix"> •</span>Concept ID: </dt><dd><a href="/medgen/docs/help/#sources" target="_blank" title="Concept Unique Identifier from NLM's Unified Medical Language system (UMLS) Click for more information.">C0043031</a></dd><dt><span class="dotprefix"> •</span></dt><dd>Pharmacologic Substance</dd></dl></div></div></div>
|
||
<div class="spaceAbove">A synthetic anticoagulant. Warfarin inhibits the regeneration of vitamin K1 epoxide and so the synthesis of vitamin K dependent clotting factors, which include Factors II, VII, IX and X, and the anticoagulant proteins C and S. This inhibition results in a sequential depression of Factors VII, IX, X and II activities. Vitamin K is an essential cofactor for the post ribosomal synthesis of the vitamin K dependent clotting factors. The vitamin promotes the biosynthesis of gamma-carboxyglutamic acid residues in these proteins which are essential for biological activity. [from NCI]</div></div>
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<div class="hangingIndent"><a title="click for more information" class="jig-ncbipopper" href="#drug_22695" data-jigconfig="hasArrow: true, openEvent: 'click', closeEvent: 'mouseout', openAnimation: 'fadeIn', closeAnimation: 'fadeOut', triggerPosition: 'center right', destPosition: 'center left', arrowDirection: 'left'">Warfarin</a></div></td></tr>
|
||
<tr><td colspan="2" class="small"> </td></tr><tr><td><a class="help jig-ncbi-popper" data-jig="ncbipopper" href="#target-gene-loc">Genes (locations):<img class="pulldown" src="//static.pubmed.gov/portal/portal3rc.fcgi/4223267/img/4204968" /></a><div class="display-none" id="target-gene-loc">
|
||
Gene(s) directly associated with<br />
|
||
this condition or phenotype.</div></td>
|
||
<td><a target="_blank" title="CYP2A6 - ID: 1548 - NCBI Gene" href="/gene/1548" class="medgenPMinfo">CYP2A6</a> (19q13.2); <a target="_blank" title="CYP2C9 - ID: 1559 - NCBI Gene" href="/gene/1559" class="medgenPMinfo">CYP2C9</a> (10q23.33); <a target="_blank" title="VKORC1 - ID: 79001 - NCBI Gene" href="/gene/79001" class="medgenPMinfo">VKORC1</a> (16p11.2)</td></tr>
|
||
<tr><td colspan="2" class="small"> </td></tr><tr><td>Monarch Initiative:</td>
|
||
<td><a href="https://monarchinitiative.org/disease/MONDO:0007390" target="_blank">MONDO:0007390</a></td></tr>
|
||
<tr><td>OMIM<span class="superscript">®</span>:</td>
|
||
<td><a href="https://omim.org/entry/122700" target="_blank">122700</a></td></tr>
|
||
</tbody></table></div><div class="rprt-body jig-ncbiinpagenav" data-jigconfig="smoothScroll: false, gotoTopLink: true, gotoTopLinkText: '', gotoTopLinkAttrs: {'title': 'Go to the top of the page'},allHeadingLevels: ['h1'], topOfPageTOC: true, tocId: 'my-toc'"><div id="rprt-tabs-1" class="rprt-tab"><div id="tb-termsProp-1"><div class="leftCol mgCol"><div>
|
||
<div class="portlet mgSection" id="ID_100">
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||
<div class="portlet_head mgSectionHead ui-widget-header"><h1 class="nl" id="Definition">Definition</h1><a sid="100" href="#" class="portlet_shutter" title="Show/hide content"></a></div>
|
||
<div class="portlet_content ln">Warfarin is an oral anti-coagulant used world-wide to treat and prevent thrombotic disorders. While it is highly effective, it has a very narrow therapeutic index making it difficult to dose correctly. Genetic variants in cytochrome P450-2C9 (CYP2C9), vitamin K-epoxide reductase complex (VKORC1), cytochrome P450-CYP4F2 (CYP4F2) and the CYP2C cluster (eg. rs12777823), along with non-genetic factors, are known to affect warfarin dose variability. Patients with specific variants in the gene CYP2C9 (the primary warfarin-metabolizing enzyme) may require a lower dose of warfarin as compared to patients without these variants. Patients with specific variants in VKORC1 (the target enzyme of warfarin) may require a lower warfarin dose as compared to patients who do not have these variants. The combination of CYP2C9/VKORC1/CYP4F2/CYP2C genetic variants, along with clinical factors, can put some patients at risk for therapeutic failure or adverse events such as bleeding. Guidelines regarding the use of pharmacogenomic tests in dosing for warfarin have been published in Clinical Pharmacology and Therapeutics by the Clinical Pharmacogenetics Implementation Consortium (CPIC) and are available on the CPIC and PharmGKB websites. [from <a title="The Pharmacogenomics Knowledge Base" href="http://www.pharmgkb.org" class="defSource" target="_blank">PharmGKB</a>]</div>
|
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</div>
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<div class="portlet mgSection" id="ID_117">
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<div class="portlet_head mgSectionHead ui-widget-header"><h1 class="nl" id="Additional_descriptions">Additional descriptions</h1><a sid="117" href="#" class="portlet_shutter" title="Show/hide content"></a></div>
|
||
<div class="portlet_content ln"><div class="mgSection"><strong>From Medical Genetics Summaries</strong><br />Warfarin (brand name Coumadin) is an anticoagulant (blood thinner). Warfarin acts by inhibiting the synthesis of vitamin K-dependent clotting factors and is used in the prevention and treatment of various thrombotic disorders. Warfarin is a drug with narrow therapeutic index; thus, a small change in its plasma levels may result in concentration dependent adverse drug reactions or therapeutic failure. Therefore, the dose of warfarin must be tailored for each patient according to the patient’s response, measured as INR (International Normalized Ratio), and the condition being treated. There is a wide inter-individual variability in the dose of warfarin required to achieve target anticoagulation, and the time it takes to reach target INR. Approximately half of this variability is known to be caused by clinical or lifestyle factors (e.g., a patient’s age, weight, BMI, gender, smoking status, existing conditions, and concomitant medications) and by genetic factors (known genetic factors include variants in the VKORC1, CYP2C9, CYP4F2 genes, and the rs12777823 variant in the CYP2C gene cluster on chromosome 10). The VKORC1 and CYP2C9 genotypes are the most important known genetic determinants of warfarin dosing. Warfarin targets VKORC1, an enzyme involved in vitamin K recycling. A common variant, VKORC1, c.-1639G>A, is associated with an increased sensitivity to warfarin and lower dose requirements. The CYP2C9 enzyme metabolizes warfarin and the variants CYP2C9*2 and *3, are also associated with lower dose requirements. The FDA-approved drug label for warfarin states that CYP2C9 and VKORC1 genotype information, when available, can assist in the selection of the initial dose of warfarin. The label provides 2 sets of warfarin dosing recommendations, for when the CYP2C9 and VKORC1 genotypes are either known or not known (taking into account clinical factors, the initial dose of warfarin is usually 2–5 mg once daily). In addition, the Dutch Pharmacogenetics Working Group (DPWG) of the Royal Dutch Association for the Advancement of Pharmacy (KNMP) has published recommendations for the initial standard dose of warfarin. A dose reduction is recommended for individuals who are CYP2C9 poor and intermediate metabolizers (with the exception of intermediate metabolizers with the CYP2C9*1/*2 genotype, no dose change is required), and a dose reduction is recommended for individuals who carry 2 copies of the variant VKORC1 A allele (VKORC1, c.-1639G>A/A). Recently, genetic variation in the CYP4F2 gene, and a variant near the CYP2C gene cluster, rs12777823, have been associated with influencing warfarin therapy. The CYP4F2*3 variant is associated with a modest increase in warfarin dose requirements in individuals with European or Asian ancestry, while in individuals with African ancestry, the rs12777823 A/G or A/A genotype is associated with decreased warfarin dose requirements. The 2017 Update of the Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for Pharmacogenetics-Guided Warfarin Dosing, provides warfarin dosing recommendations for adults with and without African ancestry, and also for pediatric patients. CPIC recommends that these dosing guidelines are applied after a warfarin dose has been calculated using a validated pharmacogenetic algorithm, which includes genotype information for VKORC1, c.-1639G>A and CYP2C9*2 and *3. <a target="_blank" href="https://www.ncbi.nlm.nih.gov/books/NBK84174">https://www.ncbi.nlm.nih.gov/books/NBK84174</a></div><div class="mgSection"><strong>From MedlinePlus Genetics</strong><br />Warfarin resistance is a condition in which individuals have a high tolerance for the drug warfarin. Warfarin is an anticoagulant, which means that it thins the blood, preventing blood clots from forming. Warfarin is often prescribed to prevent blood clots in people with heart valve disease who have replacement heart valves, people with an irregular heart beat (atrial fibrillation), or those with a history of heart attack, stroke, or a prior blood clot in the deep veins of the arms or legs (deep vein thrombosis).<br /><br />There are two types of warfarin resistance: incomplete and complete. Those with incomplete warfarin resistance can achieve the benefits of warfarin treatment with a high dose of warfarin. Individuals with complete warfarin resistance do not respond to warfarin treatment, no matter how high the dose. If people with warfarin resistance require anticoagulant therapy and take the average warfarin dose, they will remain at risk of developing a potentially harmful blood clot.<br /><br />Both types of warfarin resistance are related to how the body processes warfarin. In some people with warfarin resistance, their blood-clotting process does not react effectively to the drug. Others rapidly break down (metabolize) warfarin, so the medication is quickly processed by their bodies; these individuals are classified as "fast metabolizers" or "rapid metabolizers" of warfarin. The severity of these abnormal processes determines whether the warfarin resistance is complete or incomplete.<br /><br />Warfarin resistance does not appear to cause any health problems other than those associated with warfarin drug treatment. <a target="_blank" href="https://medlineplus.gov/genetics/condition/warfarin-resistance">https://medlineplus.gov/genetics/condition/warfarin-resistance</a></div><div class="mgSection"><strong>From MedlinePlus Genetics</strong><br />Warfarin sensitivity is a condition in which individuals have a low tolerance for the drug warfarin. Warfarin is an anticoagulant, which means that it thins the blood, preventing blood clots from forming. Warfarin is often prescribed to prevent blood clots in people with heart valve disease who have replacement heart valves, people with an irregular heart beat (atrial fibrillation), or those with a history of heart attack, stroke, or a prior blood clot in the deep veins of the arms or legs (deep vein thrombosis).<br /><br />Many people with warfarin sensitivity take longer than normal to break down (metabolize) warfarin. The medication remains active in their body longer than usual, so they require lower doses. These individuals are classified as "slow metabolizers" of warfarin. Other people with warfarin sensitivity do not need as much drug to prevent clots because their clot-forming process is naturally slower than average and can be stopped by low warfarin doses. If people with warfarin sensitivity take the average dose (or more) of warfarin, they are at risk of an overdose, which can cause abnormal bleeding in the brain, gastrointestinal tract, or other tissues, and may lead to serious health problems or death.<br /><br />Warfarin sensitivity does not appear to cause any health problems other than those associated with warfarin drug treatment. <a target="_blank" href="https://medlineplus.gov/genetics/condition/warfarin-sensitivity">https://medlineplus.gov/genetics/condition/warfarin-sensitivity</a></div></div>
|
||
</div>
|
||
|
||
<div class="portlet mgSection" id="ID_102">
|
||
<div class="portlet_head mgSectionHead ui-widget-header"><h1 class="nl" id="Clinical_features">Clinical features</h1><a sid="102" href="#" class="portlet_shutter" title="Show/hide content"></a></div>
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||
<div class="portlet_content ln clinfeat"><strong>From HPO</strong><br />
|
||
<div class="divPopper rprt" id="clin_163092"><div><strong>Abnormality of blood and blood-forming tissues</strong><div class="aux"><div class="resc"><dl class="rprtid"><dt>MedGen UID: </dt><dd>163092</dd><dt><span class="dotprefix"> •</span>Concept ID: </dt><dd><a href="/medgen/docs/help/#sources" target="_blank" title="Concept Unique Identifier from NLM's Unified Medical Language system (UMLS) Click for more information.">C0850715</a></dd><dt><span class="dotprefix"> •</span></dt><dd>Finding</dd></dl></div></div></div>
|
||
<div class="spaceAbove">An abnormality of the hematopoietic system.</div>
|
||
<div class="spaceAbove nowrap">See: <a href="/medgen/163092">Feature record</a> | <a href="/medgen?term=%22Abnormality%20of%20blood%20and%20blood-forming%20tissues%22%5BClinical%20Features%5D%20OR%20163092%5Buid%5D">Search on this feature</a></div></div><div class="TreeLite"><ul><li><span class="TLline">Abnormality of blood and blood-forming tissues</span><ul><li class="TLline">
|
||
<span class="TLline"><a title="click for more information" class="jig-ncbipopper" href="#clin_163092" data-jigconfig="hasArrow: true, openEvent: 'click', closeEvent: 'mouseout', openAnimation: 'fadeIn', closeAnimation: 'fadeOut', triggerPosition: 'center right', destPosition: 'center left', arrowDirection: 'left'">Abnormality of blood and blood-forming tissues</a></span></li></ul></li></ul></div></div>
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||
</div>
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||
|
||
<div class="portlet mgSection" id="ID_105">
|
||
<div class="portlet_head mgSectionHead ui-widget-header"><h1 class="nl" id="Professional_guidelines">Professional guidelines</h1><a sid="105" href="#" class="portlet_shutter" title="Show/hide content"></a></div>
|
||
<div class="portlet_content ln"><h3 class="subhead">PubMed<a class="help jig-ncbi-popper" data-jig="ncbipopper" href="#guidelinesHelpPM"><img class="pulldown" src="//static.pubmed.gov/portal/portal3rc.fcgi/4223267/img/4204968" /></a></h3>
|
||
<div class="nl"><a target="_blank" href="/pubmed/38033089">2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Joglar JA,
|
||
Chung MK,
|
||
Armbruster AL,
|
||
Benjamin EJ,
|
||
Chyou JY,
|
||
Cronin EM,
|
||
Deswal A,
|
||
Eckhardt LL,
|
||
Goldberger ZD,
|
||
Gopinathannair R,
|
||
Gorenek B,
|
||
Hess PL,
|
||
Hlatky M,
|
||
Hogan G,
|
||
Ibeh C,
|
||
Indik JH,
|
||
Kido K,
|
||
Kusumoto F,
|
||
Link MS,
|
||
Linta KT,
|
||
Marcus GM,
|
||
McCarthy PM,
|
||
Patel N,
|
||
Patton KK,
|
||
Perez MV,
|
||
Piccini JP,
|
||
Russo AM,
|
||
Sanders P,
|
||
Streur MM,
|
||
Thomas KL,
|
||
Times S,
|
||
Tisdale JE,
|
||
Valente AM,
|
||
Van Wagoner DR;
|
||
Peer Review Committee Members</span><br />
|
||
<span class="medgenPMjournal">Circulation</span>
|
||
2024 Jan 2;149(1):e1-e156.
|
||
Epub 2023 Nov 30
|
||
doi: 10.1161/CIR.0000000000001193.
|
||
<span class="bold">PMID: </span><a href="/pubmed/38033089" target="_blank">38033089</a><a href="/pmc/articles/PMC11095842" target="_blank" class="PubMedFree">Free PMC Article</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/35964704">Perioperative Management of Antithrombotic Therapy: An American College of Chest Physicians Clinical Practice Guideline.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Douketis JD,
|
||
Spyropoulos AC,
|
||
Murad MH,
|
||
Arcelus JI,
|
||
Dager WE,
|
||
Dunn AS,
|
||
Fargo RA,
|
||
Levy JH,
|
||
Samama CM,
|
||
Shah SH,
|
||
Sherwood MW,
|
||
Tafur AJ,
|
||
Tang LV,
|
||
Moores LK</span><br />
|
||
<span class="medgenPMjournal">Chest</span>
|
||
2022 Nov;162(5):e207-e243.
|
||
Epub 2022 Aug 11
|
||
doi: 10.1016/j.chest.2022.07.025.
|
||
<span class="bold">PMID: </span><a href="/pubmed/35964704" target="_blank">35964704</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/31155730">Deep vein thrombosis: update on diagnosis and management.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Kruger PC,
|
||
Eikelboom JW,
|
||
Douketis JD,
|
||
Hankey GJ</span><br />
|
||
<span class="medgenPMjournal">Med J Aust</span>
|
||
2019 Jun;210(11):516-524.
|
||
Epub 2019 Jun 2
|
||
doi: 10.5694/mja2.50201.
|
||
<span class="bold">PMID: </span><a href="/pubmed/31155730" target="_blank">31155730</a></div>
|
||
<div><a target="_blank" href="https://pubmed.ncbi.nlm.nih.gov/?term=(%22warfarin%22%5Btiab%3A~0%5D)%20AND%20(%22english%20and%20humans%22%5BFilter%5D)%20AND%20(%20(%22practice%20guideline%22%5BFilter%5D)%20OR%20(practice*%5Btitl%5D%20AND%20(guideline%5Btitl%5D%20OR%20parameter%5Btitl%5D%20OR%20resource%5Btitl%5D%20OR%20bulletin%5Btitl%5D%20OR%20best%5Btitl%5D))%20OR%20(genetic*%5Btitl%5D%20AND%20(evaluation%5Btitl%5D%20OR%20counseling%5Btitl%5D%20OR%20screening%5Btitl%5D%20OR%20test*%5Btitl%5D))%20OR%20(clinical%5Btitl%5D%20AND%20((expert%5Btitl%5D%20AND%20consensus%5Btitl%5D)%20OR%20utility%5Btitl%5D%20OR%20guideline*%5Btitl%5D))%20OR%20(management%5Btitl%5D%20AND%20(clinical%5Btitl%5D%20OR%20diagnos*%5Btitl%5D%20OR%20recommendation%5Btitl%5D%20OR%20pain%5Btitl%5D%20OR%20surveillance%5Btitl%5D%20OR%20emergency%5Btitl%5D%20OR%20guideline*%5Btitl%5D%20OR%20therap*))%20OR%20(treatment%5Btitl%5D%20AND%20((evaluation%5Btitl%5D%20AND%20diagnosis%5Btitl%5D)%20OR%20(assessment%5Btitl%5D%20AND%20prevention%5Btitl%5D)%20OR%20therap*))%20OR%20(Diagnos*%5Btitl%5D%20AND%20(prenatal%5Btitl%5D%20OR%20treatment%5Btitl%5D%20OR%20follow-up%5Btitl%5D%20OR%20statement%5Btitl%5D%20OR%20criteria%5Btitl%5D%20OR%20newborn%5Btitl%5D%20OR%20differential%5Btitl%5D%20OR%20neonatal%5Btitl%5D%20OR%20neonate%5Btitl%5D))%20OR%20(guideline*%5Btitl%5D%20AND%20(pharmacogenetic*%5Btitl%5D%20OR%20recommendation%5Btitl%5D%20OR%20therap*%5Btitl%5D%20OR%20evidence-based%5Btitl%5D%20OR%20consensus%5Btitl%5D%20OR%20(technical%5Btitl%5D%20AND%20standard*%5Btitl%5D)%20OR%20(molecular%5Btitl%5D%20AND%20testing%5Btitl%5D)))%20OR%20(risk%5Btitl%5D%20AND%20assessment%5Btitl%5D)%20OR%20(recommendation*%5Btitl%5D%20AND%20(statement%5Btitl%5D%20OR%20Evidence-based%5Btitl%5D%20OR%20Consensus%5Btitl%5D))%20OR%20(care%20AND%20((Patient%5Btitl%5D%20AND%20standard*%5Btitl%5D)%20OR%20primary%5Btitl%5D%20OR%20psychosocial%5Btitl%5D))%20OR%20(Health%5Btitl%5D%20AND%20supervision%5Btitl%5D)%20OR%20(statement%5Btitl%5D%20AND%20(policy%5Btitl%5D%20OR%20position%5Btitl%5D%20OR%20Consensus%5Btitl%5D))%20OR%20(pharmacogenetics%5Btitl%5D%20AND%20(Dosing%5Btitl%5D%20OR%20therap*%5Btitl%5D%20OR%20genotype*%5Btitl%5D%20OR%20drug*%5Btitl%5D))%20OR%20(Chemotherapy%5Btitl%5D%20AND%20decision*%5Btitl%5D)%20OR%20(screening%5Btitl%5D%20AND%20(newborn%5Btitl%5D%20OR%20neonat*%5Btitl%5D%20OR%20detection%5Btitl%5D%20OR%20diagnos*%5Btitl%5D))%20OR%20(criteria%5Btitl%5D%20OR%20genotype*%5Btitl%5D)%20)%20NOT%20(%22Case%20reports%22%5BPublication%20type%5D%20OR%20%22clinical%20study%22%5BPublication%20Type%5D%20OR%20%22randomized%20controlled%20trial%22%5BPublication%20Type%5D)" title="PubMed search">See all (2253)</a></div><h3 class="subhead">Curated<a class="help jig-ncbi-popper" data-jig="ncbipopper" href="#guidelinesHelpCurated"><img class="pulldown" src="//static.pubmed.gov/portal/portal3rc.fcgi/4223267/img/4204968" /></a></h3><h3 class="nl vspace"><a href="https://www.aacc.org/science-and-practice/practice-guidelines/pharmacogenetics" target="_blank">National Academy of Clinical Biochemistry, Clinical practice considerations. In: Laboratory medicine practice guidelines: guidelines and recommendations for laboratory analysis and application of pharmacogenetics to clinical practice, 2010</a></h3>
|
||
</div>
|
||
</div>
|
||
<div class="display-none help-popup" id="guidelinesHelpPM">These guidelines are articles in PubMed that match specific search criteria developed by MedGen to capture the most relevant practice guidelines. This list may not be comprehensive and may include broader topics as well. See the <a href="/medgen/docs/faq/" title="Frequently asked questions" target="_blank">FAQ</a> for details.</div><div class="display-none help-popup" id="guidelinesHelpCurated">These guidelines are manually curated by the MedGen team
|
||
to supplement articles available in PubMed. See the <a href="/medgen/docs/faq/" title="Frequently asked questions" target="_blank">FAQ</a> for details.</div>
|
||
<div class="portlet mgSection" id="ID_114">
|
||
<div class="portlet_head mgSectionHead ui-widget-header"><h1 class="nl" id="Suggested_Reading">Suggested Reading</h1><a sid="114" href="#" class="portlet_shutter" title="Show/hide content"></a></div>
|
||
<div class="portlet_content ln"><h3 class="subhead">PubMed</h3>
|
||
<div class="nl"><a target="_blank" href="/pubmed/24251364">Do pharmacogenetics have a role in the dosing of vitamin K antagonists?</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Furie B</span><br />
|
||
<span class="medgenPMjournal">N Engl J Med</span>
|
||
2013 Dec 12;369(24):2345-6.
|
||
Epub 2013 Nov 19
|
||
doi: 10.1056/NEJMe1313682.
|
||
<span class="bold">PMID: </span><a href="/pubmed/24251364" target="_blank">24251364</a></div>
|
||
<div><a target="_blank" href="https://pubmed.ncbi.nlm.nih.gov/?term=" title="PubMed search"></a></div><h3 class="subhead">External</h3><h3 class="nl vspace"><a href="http://www.warfarindosing.org" target="_blank">WarfarinDosing.org</a></h3>
|
||
</div>
|
||
</div>
|
||
|
||
<div class="portlet mgSection" id="ID_103">
|
||
<div class="portlet_head mgSectionHead ui-widget-header"><h1 class="nl" id="Recent_clinical_studies">Recent clinical studies</h1><a sid="103" href="#" class="portlet_shutter" title="Show/hide content"></a></div>
|
||
<div class="portlet_content ln"><h3 class="subhead">Etiology</h3>
|
||
<div class="nl"><a target="_blank" href="/pubmed/38443337">Being precise with anticoagulation to reduce adverse drug reactions: are we there yet?</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Cross B,
|
||
Turner RM,
|
||
Zhang JE,
|
||
Pirmohamed M</span><br />
|
||
<span class="medgenPMjournal">Pharmacogenomics J</span>
|
||
2024 Mar 5;24(2):7.
|
||
doi: 10.1038/s41397-024-00329-y.
|
||
<span class="bold">PMID: </span><a href="/pubmed/38443337" target="_blank">38443337</a><a href="/pmc/articles/PMC10914631" target="_blank" class="PubMedFree">Free PMC Article</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/34357562">Cardiovascular Pharmacogenomics: An Update on Clinical Studies of Antithrombotic Drugs in Brazilian Patients.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Hirata TDC,
|
||
Dagli-Hernandez C,
|
||
Genvigir FDV,
|
||
Lauschke VM,
|
||
Zhou Y,
|
||
Hirata MH,
|
||
Hirata RDC</span><br />
|
||
<span class="medgenPMjournal">Mol Diagn Ther</span>
|
||
2021 Nov;25(6):735-755.
|
||
Epub 2021 Aug 6
|
||
doi: 10.1007/s40291-021-00549-z.
|
||
<span class="bold">PMID: </span><a href="/pubmed/34357562" target="_blank">34357562</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/29701078">Genotype-guided warfarin therapy: current status.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Tavares LC,
|
||
Marcatto LR,
|
||
Santos PCJL</span><br />
|
||
<span class="medgenPMjournal">Pharmacogenomics</span>
|
||
2018 May;19(7):667-685.
|
||
Epub 2018 Apr 27
|
||
doi: 10.2217/pgs-2017-0207.
|
||
<span class="bold">PMID: </span><a href="/pubmed/29701078" target="_blank">29701078</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/22023024">The pharmacogenetics of the response to warfarin in Chinese.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Lam MP,
|
||
Cheung BM</span><br />
|
||
<span class="medgenPMjournal">Br J Clin Pharmacol</span>
|
||
2012 Mar;73(3):340-7.
|
||
doi: 10.1111/j.1365-2125.2011.04097.x.
|
||
<span class="bold">PMID: </span><a href="/pubmed/22023024" target="_blank">22023024</a><a href="/pmc/articles/PMC3370339" target="_blank" class="PubMedFree">Free PMC Article</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/18752379">Warfarin pharmacogenetics.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Limdi NA,
|
||
Veenstra DL</span><br />
|
||
<span class="medgenPMjournal">Pharmacotherapy</span>
|
||
2008 Sep;28(9):1084-97.
|
||
doi: 10.1592/phco.28.9.1084.
|
||
<span class="bold">PMID: </span><a href="/pubmed/18752379" target="_blank">18752379</a><a href="/pmc/articles/PMC2756787" target="_blank" class="PubMedFree">Free PMC Article</a></div>
|
||
<div><a target="_blank" href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Warfarin%20response%22%20AND%20Etiology%2Fbroad%5Bfilter%5D%20%20AND%20%22english%20and%20humans%22%5Bfilter%5D%20NOT%20comment%5BPTYP%5D%20NOT%20letter%5BPTYP%5D" title="PubMed search">See all (65)</a></div><h3 class="subhead">Diagnosis</h3>
|
||
<div class="nl"><a target="_blank" href="/pubmed/34460938">Predicting Range of Initial Warfarin Dose Based on Pharmacometabolomic and Genetic Inputs.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Huang Q,
|
||
Cao L,
|
||
Luo N,
|
||
Qian H,
|
||
Wei M,
|
||
Xue L,
|
||
Zhou Q,
|
||
Zou B,
|
||
Tan L,
|
||
Chu Y,
|
||
Ma X,
|
||
Wang C,
|
||
Wu H,
|
||
Zhang L,
|
||
Sun L,
|
||
Li D,
|
||
Fan X,
|
||
Miao L,
|
||
Zhou G</span><br />
|
||
<span class="medgenPMjournal">Clin Pharmacol Ther</span>
|
||
2021 Dec;110(6):1585-1594.
|
||
Epub 2021 Sep 13
|
||
doi: 10.1002/cpt.2407.
|
||
<span class="bold">PMID: </span><a href="/pubmed/34460938" target="_blank">34460938</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/34357562">Cardiovascular Pharmacogenomics: An Update on Clinical Studies of Antithrombotic Drugs in Brazilian Patients.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Hirata TDC,
|
||
Dagli-Hernandez C,
|
||
Genvigir FDV,
|
||
Lauschke VM,
|
||
Zhou Y,
|
||
Hirata MH,
|
||
Hirata RDC</span><br />
|
||
<span class="medgenPMjournal">Mol Diagn Ther</span>
|
||
2021 Nov;25(6):735-755.
|
||
Epub 2021 Aug 6
|
||
doi: 10.1007/s40291-021-00549-z.
|
||
<span class="bold">PMID: </span><a href="/pubmed/34357562" target="_blank">34357562</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/22114699">Clinical and genetic determinants of warfarin pharmacokinetics and pharmacodynamics during treatment initiation.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Gong IY,
|
||
Schwarz UI,
|
||
Crown N,
|
||
Dresser GK,
|
||
Lazo-Langner A,
|
||
Zou G,
|
||
Roden DM,
|
||
Stein CM,
|
||
Rodger M,
|
||
Wells PS,
|
||
Kim RB,
|
||
Tirona RG</span><br />
|
||
<span class="medgenPMjournal">PLoS One</span>
|
||
2011;6(11):e27808.
|
||
Epub 2011 Nov 16
|
||
doi: 10.1371/journal.pone.0027808.
|
||
<span class="bold">PMID: </span><a href="/pubmed/22114699" target="_blank">22114699</a><a href="/pmc/articles/PMC3218053" target="_blank" class="PubMedFree">Free PMC Article</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/17496169">Building individualized medicine: prevention of adverse reactions to warfarin therapy.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Krynetskiy E,
|
||
McDonnell P</span><br />
|
||
<span class="medgenPMjournal">J Pharmacol Exp Ther</span>
|
||
2007 Aug;322(2):427-34.
|
||
Epub 2007 May 11
|
||
doi: 10.1124/jpet.106.117952.
|
||
<span class="bold">PMID: </span><a href="/pubmed/17496169" target="_blank">17496169</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/15831631">Warfarin: a case history in pharmacogenetics.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Hall AM,
|
||
Wilkins MR</span><br />
|
||
<span class="medgenPMjournal">Heart</span>
|
||
2005 May;91(5):563-4.
|
||
doi: 10.1136/hrt.2004.051771.
|
||
<span class="bold">PMID: </span><a href="/pubmed/15831631" target="_blank">15831631</a><a href="/pmc/articles/PMC1768901" target="_blank" class="PubMedFree">Free PMC Article</a></div>
|
||
<div><a target="_blank" href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Warfarin%20response%22%20AND%20Diagnosis%2Fbroad%5Bfilter%5D%20%20AND%20%22english%20and%20humans%22%5Bfilter%5D%20NOT%20comment%5BPTYP%5D%20NOT%20letter%5BPTYP%5D" title="PubMed search">See all (31)</a></div><h3 class="subhead">Therapy</h3>
|
||
<div class="nl"><a target="_blank" href="/pubmed/38443337">Being precise with anticoagulation to reduce adverse drug reactions: are we there yet?</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Cross B,
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Turner RM,
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Zhang JE,
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Pirmohamed M</span><br />
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<span class="medgenPMjournal">Pharmacogenomics J</span>
|
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2024 Mar 5;24(2):7.
|
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doi: 10.1038/s41397-024-00329-y.
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<span class="bold">PMID: </span><a href="/pubmed/38443337" target="_blank">38443337</a><a href="/pmc/articles/PMC10914631" target="_blank" class="PubMedFree">Free PMC Article</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/29701078">Genotype-guided warfarin therapy: current status.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Tavares LC,
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Marcatto LR,
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Santos PCJL</span><br />
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<span class="medgenPMjournal">Pharmacogenomics</span>
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2018 May;19(7):667-685.
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Epub 2018 Apr 27
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<span class="bold">PMID: </span><a href="/pubmed/29701078" target="_blank">29701078</a></div>
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<div class="nl"><a target="_blank" href="/pubmed/29110602">Pharmacometabonomics Technique to Identify Warfarin Response Using Nuclear Magnetic Resonance Spectroscopy.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Bawadikji AA,
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Teh CH,
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Kader MABSA,
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Sulaiman SAS,
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Ibrahim B</span><br />
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<span class="medgenPMjournal">Curr Pharm Biotechnol</span>
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2017;18(9):740-747.
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doi: 10.2174/1389201018666171103141828.
|
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<span class="bold">PMID: </span><a href="/pubmed/29110602" target="_blank">29110602</a></div>
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<div class="nl"><a target="_blank" href="/pubmed/22023024">The pharmacogenetics of the response to warfarin in Chinese.</a></div>
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<div class="portlet_content ln"><span class="medgenPMauthor">Lam MP,
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Cheung BM</span><br />
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<span class="medgenPMjournal">Br J Clin Pharmacol</span>
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2012 Mar;73(3):340-7.
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doi: 10.1111/j.1365-2125.2011.04097.x.
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<span class="bold">PMID: </span><a href="/pubmed/22023024" target="_blank">22023024</a><a href="/pmc/articles/PMC3370339" target="_blank" class="PubMedFree">Free PMC Article</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/18752379">Warfarin pharmacogenetics.</a></div>
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<div class="portlet_content ln"><span class="medgenPMauthor">Limdi NA,
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Veenstra DL</span><br />
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<span class="medgenPMjournal">Pharmacotherapy</span>
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2008 Sep;28(9):1084-97.
|
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doi: 10.1592/phco.28.9.1084.
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<span class="bold">PMID: </span><a href="/pubmed/18752379" target="_blank">18752379</a><a href="/pmc/articles/PMC2756787" target="_blank" class="PubMedFree">Free PMC Article</a></div>
|
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<div><a target="_blank" href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Warfarin%20response%22%20AND%20Therapy%2Fbroad%5Bfilter%5D%20%20AND%20%22english%20and%20humans%22%5Bfilter%5D%20NOT%20comment%5BPTYP%5D%20NOT%20letter%5BPTYP%5D" title="PubMed search">See all (87)</a></div><h3 class="subhead">Prognosis</h3>
|
||
<div class="nl"><a target="_blank" href="/pubmed/34821506">The importance of including African populations in pharmacogenetics studies of warfarin response.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Dandara C,
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Ndadza A,
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Soko N</span><br />
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<span class="medgenPMjournal">Pharmacogenomics</span>
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2022 Jan;23(1):1-4.
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Epub 2021 Nov 25
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doi: 10.2217/pgs-2021-0142.
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<span class="bold">PMID: </span><a href="/pubmed/34821506" target="_blank">34821506</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/29494962">Association between apolipoprotein E genotype and warfarin response during initial anticoagulation.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">He S,
|
||
Zhang H,
|
||
Cao Y,
|
||
Nian F,
|
||
Chen H,
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Chen W,
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Auchoybur ML,
|
||
Yin L,
|
||
Tao Z,
|
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Tang S,
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Chen X</span><br />
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<span class="medgenPMjournal">Biomed Pharmacother</span>
|
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2018 May;101:251-256.
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Epub 2018 Feb 27
|
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doi: 10.1016/j.biopha.2018.02.095.
|
||
<span class="bold">PMID: </span><a href="/pubmed/29494962" target="_blank">29494962</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/29110602">Pharmacometabonomics Technique to Identify Warfarin Response Using Nuclear Magnetic Resonance Spectroscopy.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Bawadikji AA,
|
||
Teh CH,
|
||
Kader MABSA,
|
||
Sulaiman SAS,
|
||
Ibrahim B</span><br />
|
||
<span class="medgenPMjournal">Curr Pharm Biotechnol</span>
|
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2017;18(9):740-747.
|
||
doi: 10.2174/1389201018666171103141828.
|
||
<span class="bold">PMID: </span><a href="/pubmed/29110602" target="_blank">29110602</a></div>
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||
<div class="nl"><a target="_blank" href="/pubmed/25181036">Is personalized medicine a dream or a reality?</a></div>
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<div class="portlet_content ln"><span class="medgenPMauthor">Morse BL,
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Kim RB</span><br />
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<span class="medgenPMjournal">Crit Rev Clin Lab Sci</span>
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2015 Feb;52(1):1-11.
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Epub 2014 Sep 2
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doi: 10.3109/10408363.2014.950407.
|
||
<span class="bold">PMID: </span><a href="/pubmed/25181036" target="_blank">25181036</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/22114699">Clinical and genetic determinants of warfarin pharmacokinetics and pharmacodynamics during treatment initiation.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Gong IY,
|
||
Schwarz UI,
|
||
Crown N,
|
||
Dresser GK,
|
||
Lazo-Langner A,
|
||
Zou G,
|
||
Roden DM,
|
||
Stein CM,
|
||
Rodger M,
|
||
Wells PS,
|
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Kim RB,
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Tirona RG</span><br />
|
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<span class="medgenPMjournal">PLoS One</span>
|
||
2011;6(11):e27808.
|
||
Epub 2011 Nov 16
|
||
doi: 10.1371/journal.pone.0027808.
|
||
<span class="bold">PMID: </span><a href="/pubmed/22114699" target="_blank">22114699</a><a href="/pmc/articles/PMC3218053" target="_blank" class="PubMedFree">Free PMC Article</a></div>
|
||
<div><a target="_blank" href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Warfarin%20response%22%20AND%20Prognosis%2Fbroad%5Bfilter%5D%20%20AND%20%22english%20and%20humans%22%5Bfilter%5D%20NOT%20comment%5BPTYP%5D%20NOT%20letter%5BPTYP%5D" title="PubMed search">See all (40)</a></div><h3 class="subhead">Clinical prediction guides</h3>
|
||
<div class="nl"><a target="_blank" href="/pubmed/34821506">The importance of including African populations in pharmacogenetics studies of warfarin response.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Dandara C,
|
||
Ndadza A,
|
||
Soko N</span><br />
|
||
<span class="medgenPMjournal">Pharmacogenomics</span>
|
||
2022 Jan;23(1):1-4.
|
||
Epub 2021 Nov 25
|
||
doi: 10.2217/pgs-2021-0142.
|
||
<span class="bold">PMID: </span><a href="/pubmed/34821506" target="_blank">34821506</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/29494962">Association between apolipoprotein E genotype and warfarin response during initial anticoagulation.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">He S,
|
||
Zhang H,
|
||
Cao Y,
|
||
Nian F,
|
||
Chen H,
|
||
Chen W,
|
||
Auchoybur ML,
|
||
Yin L,
|
||
Tao Z,
|
||
Tang S,
|
||
Chen X</span><br />
|
||
<span class="medgenPMjournal">Biomed Pharmacother</span>
|
||
2018 May;101:251-256.
|
||
Epub 2018 Feb 27
|
||
doi: 10.1016/j.biopha.2018.02.095.
|
||
<span class="bold">PMID: </span><a href="/pubmed/29494962" target="_blank">29494962</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/29110602">Pharmacometabonomics Technique to Identify Warfarin Response Using Nuclear Magnetic Resonance Spectroscopy.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Bawadikji AA,
|
||
Teh CH,
|
||
Kader MABSA,
|
||
Sulaiman SAS,
|
||
Ibrahim B</span><br />
|
||
<span class="medgenPMjournal">Curr Pharm Biotechnol</span>
|
||
2017;18(9):740-747.
|
||
doi: 10.2174/1389201018666171103141828.
|
||
<span class="bold">PMID: </span><a href="/pubmed/29110602" target="_blank">29110602</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/22114699">Clinical and genetic determinants of warfarin pharmacokinetics and pharmacodynamics during treatment initiation.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Gong IY,
|
||
Schwarz UI,
|
||
Crown N,
|
||
Dresser GK,
|
||
Lazo-Langner A,
|
||
Zou G,
|
||
Roden DM,
|
||
Stein CM,
|
||
Rodger M,
|
||
Wells PS,
|
||
Kim RB,
|
||
Tirona RG</span><br />
|
||
<span class="medgenPMjournal">PLoS One</span>
|
||
2011;6(11):e27808.
|
||
Epub 2011 Nov 16
|
||
doi: 10.1371/journal.pone.0027808.
|
||
<span class="bold">PMID: </span><a href="/pubmed/22114699" target="_blank">22114699</a><a href="/pmc/articles/PMC3218053" target="_blank" class="PubMedFree">Free PMC Article</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/18752379">Warfarin pharmacogenetics.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Limdi NA,
|
||
Veenstra DL</span><br />
|
||
<span class="medgenPMjournal">Pharmacotherapy</span>
|
||
2008 Sep;28(9):1084-97.
|
||
doi: 10.1592/phco.28.9.1084.
|
||
<span class="bold">PMID: </span><a href="/pubmed/18752379" target="_blank">18752379</a><a href="/pmc/articles/PMC2756787" target="_blank" class="PubMedFree">Free PMC Article</a></div>
|
||
<div><a target="_blank" href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Warfarin%20response%22%20AND%20Clinical%20prediction%20guides%2Fbroad%5Bfilter%5D%20%20AND%20%22english%20and%20humans%22%5Bfilter%5D%20NOT%20comment%5BPTYP%5D%20NOT%20letter%5BPTYP%5D" title="PubMed search">See all (51)</a></div></div>
|
||
</div>
|
||
|
||
<div class="portlet mgSection" id="ID_104">
|
||
<div class="portlet_head mgSectionHead ui-widget-header"><h1 class="nl" id="Recent_systematic_reviews">Recent systematic reviews</h1><a sid="104" href="#" class="portlet_shutter" title="Show/hide content"></a></div>
|
||
<div class="portlet_content ln">
|
||
<div class="nl"><a target="_blank" href="/pubmed/31869433">Genetic Factors Influencing Warfarin Dose in Black-African Patients: A Systematic Review and Meta-Analysis.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Asiimwe IG,
|
||
Zhang EJ,
|
||
Osanlou R,
|
||
Krause A,
|
||
Dillon C,
|
||
Suarez-Kurtz G,
|
||
Zhang H,
|
||
Perini JA,
|
||
Renta JY,
|
||
Duconge J,
|
||
Cavallari LH,
|
||
Marcatto LR,
|
||
Beasly MT,
|
||
Perera MA,
|
||
Limdi NA,
|
||
Santos PCJL,
|
||
Kimmel SE,
|
||
Lubitz SA,
|
||
Scott SA,
|
||
Kawai VK,
|
||
Jorgensen AL,
|
||
Pirmohamed M</span><br />
|
||
<span class="medgenPMjournal">Clin Pharmacol Ther</span>
|
||
2020 Jun;107(6):1420-1433.
|
||
Epub 2020 Jan 28
|
||
doi: 10.1002/cpt.1755.
|
||
<span class="bold">PMID: </span><a href="/pubmed/31869433" target="_blank">31869433</a><a href="/pmc/articles/PMC7217737" target="_blank" class="PubMedFree">Free PMC Article</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/22952875">Influence of CYP2C9 and VKORC1 on patient response to warfarin: a systematic review and meta-analysis.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Jorgensen AL,
|
||
FitzGerald RJ,
|
||
Oyee J,
|
||
Pirmohamed M,
|
||
Williamson PR</span><br />
|
||
<span class="medgenPMjournal">PLoS One</span>
|
||
2012;7(8):e44064.
|
||
Epub 2012 Aug 29
|
||
doi: 10.1371/journal.pone.0044064.
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||
<span class="bold">PMID: </span><a href="/pubmed/22952875" target="_blank">22952875</a><a href="/pmc/articles/PMC3430615" target="_blank" class="PubMedFree">Free PMC Article</a></div>
|
||
<div><a target="_blank" href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Warfarin%20response%22%20AND%20systematic%5Bsb%5D%20AND%20%22english%20and%20humans%22%5Bfilter%5D%20NOT%20comment%5BPTYP%5D%20NOT%20letter%5BPTYP%5D" title="PubMed search">See all (2)</a></div></div>
|
||
</div>
|
||
|
||
<div class="portlet mgSection" id="ID_120">
|
||
<div class="portlet_head mgSectionHead ui-widget-header"><h1 class="nl" id="Therapeutic_recommendations">Therapeutic recommendations</h1><a sid="120" href="#" class="portlet_shutter" title="Show/hide content"></a></div>
|
||
<div class="portlet_content ln" id="therapeutic"><strong>From <a href="https://www.ncbi.nlm.nih.gov/books/NBK84174" target="_blank">Medical Genetics Summaries</a></strong><br /><div id="TheraputicContent"><div class="divPopper rprt" id="warfarin_REF_1" style="display: none;">1. WARFARIN SODIUM- warfarin tablet [package insert]. Bridgewater, NJ; March 31, 2017. Available from: <a href="https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=541c9a70-adaf-4ef3-94ba-ad4e70dfa057" target="_blank">https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=541c9a70-adaf-4ef3-94ba-ad4e70dfa057</a></div><div class="divPopper rprt" id="warfarin_REF_4" style="display: none;">4. Johnson J.A., Caudle K.E., Gong L., Whirl-Carrillo M., et al. Clinical Pharmacogenetics Implementation Consortium (CPIC) Guideline for Pharmacogenetics-Guided Warfarin Dosing: 2017 Update. Clin Pharmacol Ther. 2017 Feb 15;102(3):397–404.</div><p><b>This section contains excerpted</b>
|
||
<sup>1</sup>
|
||
<b>information on gene-based dosing recommendations. Neither this section nor other parts of this review contain the complete recommendations from the sources.</b>
|
||
</p><h2>2017 Statement from the US Food and Drug Administration (FDA)</h2><p><b>Initial and Maintenance Dosing</b>
|
||
</p><p>The appropriate initial dosing of warfarin sodium tablets varies widely for different patients. Not all factors responsible for warfarin dose variability are known, and the initial dose is influenced by:</p><ul><li>Clinical factors including age, race, body weight, sex, concomitant medications, and comorbidities</li><li>Genetic factors (<i>CYP2C9</i> and <i>VKORC1</i> genotypes)</li></ul><p>Select the initial dose based on the expected maintenance dose, taking into account the above factors. Modify this dose based on consideration of patient-specific clinical factors. Consider lower initial and maintenance doses for elderly and/or debilitated patients and in Asian patients. Routine use of loading doses is not recommended as this practice may increase hemorrhagic and other complications and does not offer more rapid protection against clot formation.</p><p>Individualize the duration of therapy for each patient. In general, anticoagulant therapy should be continued until the danger of thrombosis and embolism has passed.</p><p><b>Dosing Recommendations without Consideration of Genotype</b>
|
||
</p><p>If the patient’s <i>CYP2C9</i> and <i>VKORC1</i> genotypes are not known, the initial dose of warfarin sodium tablets is usually 2 to 5 mg once daily. Determine each patient’s dosing needs by close monitoring of the INR response and consideration of the indication being treated. Typical maintenance doses are 2 to 10 mg once daily.</p><p><b>Dosing Recommendations with Consideration of Genotype</b>
|
||
</p><p>Table 1 displays three ranges of expected maintenance warfarin sodium tablets doses observed in subgroups of patients having different combinations of CYP2C9 and VKORC1 gene variants. If the patient’s <i>CYP2C9</i> and/or <i>VKORC1</i> genotype are known, consider these ranges in choosing the initial dose. Patients with <i>CYP2C9</i> *1/*3, <i>*2/*2</i>, <i>*2/*3</i>, and <i>*3/*3</i> may require more prolonged time (>2 to 4 weeks) to achieve maximum INR effect for a given dosage regimen than patients without these CYP variants.<b>Please review the complete therapeutic recommendations that are located here:</b>
|
||
(<a title="click for more information" class="jig-ncbipopper s_TOP" href="#warfarin_REF_1" data-jigconfig="hasArrow: true, openEvent: 'click', closeEvent: 'mouseout', openAnimation: 'fadeIn', closeAnimation: 'fadeOut', triggerPosition: 'center right', destPosition: 'center left', arrowDirection: 'left'">1</a>)</p><h2>2017 Summary of recommendations from the Dutch Pharmacogenetics Working Group (DPWG) of the Royal Dutch Association for the Advancement of Pharmacy (KNMP)</h2><p><b>VKORC1 CT: warfarin</b>
|
||
</p><p>NO action is required for this gene-drug interaction.</p><p>The genetic variation results in a reduction in the required dose and an increase in the risk of excessively severe inhibition of blood clotting during the first month of the treatment. However, the effect is small and CT is also the most common genotype, meaning that the standard treatment will primarily be based on patients with this genotype.</p><p><b>VKORC1 TT: warfarin</b>
|
||
</p><p>The genetic variation results in increased sensitivity to warfarin. This results in an increase in the risk of excessively severe inhibition of blood clotting (INR >4) during the first month of the treatment.</p><p>Recommendation:</p><ol><li>use 60% of the standard initial dose</li></ol><p>The genotype-specific initial dose and maintenance dose can be calculated using an algorithm, as used in EU-PACT: see https://www.knmp.nl/patientenzorg/medicatiebewaking/farmacogenetica.</p><p>From day 6 on the standard algorithm without genotype information can be used to calculate the dose.</p><p><b>CYP2C9 IM: warfarin</b>
|
||
</p><p>This gene variation reduces the conversion of warfarin to inactive metabolites. This can increase the risk of bleeding.</p><p>Recommendation:</p><ol><li>use 65% of the standard initial dose</li></ol><p>The genotype-specific initial dose and maintenance dose can be calculated using an algorithm. Algorithms for Caucasian patients usually contain only the \*2 and \*3 allele. If the activity of the reduced-activity alleles is comparable to the activity of \*2 or \*3, then the algorithm can be completed as if \*1/\*2 or \*1/\*3 is present. See https://www.knmp.nl/patientenzorg/medicatiebewaking/farmacogenetica for Excel files containing calculation modules for oral and equivalent intravenous doses. From day 6 on the standard algorithm without genotype information can be used to calculate the dose.</p><p>Modified dose algorithms have been developed for patients of African or (East) Asian heritage.</p><p><b>CYP2C9 PM: warfarin</b>
|
||
</p><p>This gene variation reduces the conversion of warfarin to inactive metabolites. This can increase the risk of bleeding.</p><p>Recommendation:</p><ol><li>use 20% of the standard initial dose</li></ol><p>The genotype-specific initial dose and maintenance dose can be calculated using an algorithm. Algorithms for Caucasian patients usually contain only the \*2 and \*3 allele. If the activity of the reduced-activity alleles is comparable to the activity of \*2 or \*3, then the algorithm can be completed as if \*2 or \*3 is present. See https://www.knmp.nl/patientenzorg/medicatiebewaking/farmacogenetica for Excel files containing calculation modules for oral and equivalent intravenous doses. From day 6 on the standard algorithm without genotype information can be used to calculate the dose.</p><p>Modified dose algorithms have been developed for patients of African or (East) Asian heritage.</p><p><b>CYP2C9*1/*2: warfarin</b>
|
||
</p><p>NO action is required for this gene-drug interaction.</p><p>Genetic variation may lead to a decrease in the required maintenance dose. However, there is insufficient evidence that this causes problems when therapy is initiated as usual.</p><p><b>Please review the complete therapeutic recommendations located here: (</b>
|
||
<b>2, 3</b>
|
||
<b>)</b>
|
||
</p><h2>2017 Statement from the Clinical Pharmacogenetics Implementation Consortium (CPIC)</h2><p><b>Non-African ancestry recommendation</b>
|
||
</p><p>In patients who self-identify as non-African ancestry, the recommendation is to:</p><ol><li>Calculate warfarin dosing using a published pharmacogenetic algorithm, including genotype information for VKORC1-1639G>A and CYP2C9*2 and *3. In individuals with genotypes associated with CYP2C9 poor metabolism (e.g., CYP2C9 *2/*3, *3/*3) or both increased sensitivity (VKORC1-1639 A/A) and CYP2C9 poor metabolism, an alternative oral anticoagulant might be considered. The bulk of the literature informing these recommendations is in European and Asian ancestry populations, but consistent data exist for other non-African populations. These recommendations are graded as STRONG.</li><li>If a loading dose is to be utilized, the EU-PACT loading dose algorithm that incorporates genetic information could be used. This recommendation is OPTIONAL.</li><li>While <i>CYP2C9*5</i>, <i>*6</i>, <i>*8</i>, or <i>*11</i> variant alleles are commonly referred to as African-specific alleles, they can occur among individuals who do not identify as, or know of their, African ancestry. If these variant alleles are detected, decrease calculated dose by 15–30% per variant allele or consider an alternative agent. Larger dose reductions might be needed in patients homozygous for variant alleles (i.e., 20–40%, e.g., CYP2C9*2/*5). This recommendation is graded as OPTIONAL.</li><li>If the <i>CYP4F2*3</i> (i.e., c.1297A, p.433Met) allele is also detected, increase the dose by 5–10%. This recommendation is also considered OPTIONAL.</li><li>The data do not suggest an association between rs12777823 genotype and warfarin dose in non-African Americans, thus rs12777823 should not be considered in these individuals (even if available).</li></ol><p><b>African ancestry recommendation</b>
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</p><p>In patients of African ancestry, CYP2C9*5, *6, *8, *11 are important for warfarin dosing. If these genotypes are not available, warfarin should be dosed clinically without consideration for genotype. If CYP2C9*5, *6, *8, and *11 are known, then the recommendation is to:</p><ol><li>Calculate warfarin dose using a validated pharmacogenetic algorithm, including genotype information for VKORC1 c.-1639G>A and CYP2C9*2 and *3;</li><li>If the individual carries a CYP2C9*5, *6, *8, or *11 variant allele(s), decrease calculated dose by 15–30%. Larger dose reductions might be needed in patients who carry two variant alleles (e.g., CYP2C9*5/*6) (i.e., 20–40% dose reduction).</li><li>In addition, rs12777823 is associated with warfarin dosing in African Americans (mainly originating from West Africa). Thus, in African Americans a dose reduction of 10–25% in those with rs12777823 A/G or A/A genotype is recommended. These recommendations are considered MODERATE.</li></ol><p>In individuals with genotypes that predict CYP2C9 poor metabolism or who have increased warfarin sensitivity (VKORC1 c.-1639 A/A) and CYP2C9 poor metabolism, an alternative oral anticoagulant should be considered (see Supplemental Material for definitions of strength of recommendations). As noted above, for non-African ancestry, if a loading dose is to be used, the EU-PACT algorithm that incorporates genetic information could be used to calculate loading dose. This recommendation is OPTIONAL. The data do not support an impact on clinical phenotype for CYP4F2 on warfarin dosing in those of African ancestry and so no recommendation is made for use of CYP4F2 genotype data in blacks.</p><p><b>Please review the complete therapeutic recommendations, including recommendations for pediatric patients, located here:</b>
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(<a title="click for more information" class="jig-ncbipopper s_TOP" href="#warfarin_REF_4" data-jigconfig="hasArrow: true, openEvent: 'click', closeEvent: 'mouseout', openAnimation: 'fadeIn', closeAnimation: 'fadeOut', triggerPosition: 'center right', destPosition: 'center left', arrowDirection: 'left'">4</a>).</p><table id="warfarin.T.the_fda_2017_drug_label_for_w" frame="hsides" rules="groups"><caption>Table 1. The FDA (2017) Drug Label for Warfarin. Three Ranges of Expected Maintenance Warfarin Doses based on CYP2C9 and VKORC1 Genotype.</caption><tfoot><tr><td colspan="7">Ranges are derived from multiple published clinical studies. The <i>VKORC1, c.–1639G>A</i> (rs9923231) variant is used in this table. Other co-inherited <i>VKORC1</i> variants may also be important determinants of warfarin dose. Patients with <i>CYP2C9</i><i>*1/*3</i>, <i>*2/*2</i>, <i>*2/*3</i>, and <i>*3/*3</i> may require more prolonged time (>2–4 weeks) to achieve a maximum international normalized ratio (INR) effect for a given dosage regimen than patients without these <i>CYP</i> variants. Please see Therapeutic Recommendations based on Genotype for more information. This table is adapted from the FDA-approved drug label for warfarin (<a title="click for more information" class="jig-ncbipopper s_TOP" href="#warfarin_REF_1" data-jigconfig="hasArrow: true, openEvent: 'click', closeEvent: 'mouseout', openAnimation: 'fadeIn', closeAnimation: 'fadeOut', triggerPosition: 'center right', destPosition: 'center left', arrowDirection: 'left'">1</a>).</td></tr></tfoot><thead><tr><th id="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_1_1" rowspan="2" valign="top" align="left" scope="col" colspan="1" headers="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_1_1"><i>VKORC1</i></th><th id="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_1_2" colspan="6" valign="top" align="center" scope="colgroup" rowspan="1"><i>CYP2C9</i></th></tr><tr><th headers="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_1_2" id="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_2_1" valign="top" colspan="1" align="justify" scope="colgroup" rowspan="1"><i>*1/*1</i></th><th headers="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_1_2" id="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_2_2" valign="top" align="justify" scope="col" rowspan="1" colspan="1"><i>*1/*2</i></th><th headers="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_1_2" id="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_2_3" valign="top" align="justify" scope="col" rowspan="1" colspan="1"><i>*1/*3</i></th><th headers="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_1_2" id="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_2_4" valign="top" align="justify" scope="col" rowspan="1" colspan="1"><i>*2/*2</i></th><th headers="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_1_2" id="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_2_5" valign="top" align="justify" scope="col" rowspan="1" colspan="1"><i>*2/*3</i></th><th headers="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_1_2" id="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_2_6" valign="top" align="justify" scope="col" rowspan="1" colspan="1"><i>*3/*3</i></th></tr></thead><tbody><tr><td headers="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_1_1" valign="top" align="left" scope="row" rowspan="1" colspan="1">GG</td><td headers="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_1_2 hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_2_1" valign="top" align="left" rowspan="1" colspan="1">5–7 mg</td><td headers="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_1_2 hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_2_2" valign="top" align="left" rowspan="1" colspan="1">5–7 mg</td><td headers="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_1_2 hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_2_3" valign="top" align="left" rowspan="1" colspan="1">3–4 mg</td><td headers="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_1_2 hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_2_4" valign="top" align="left" rowspan="1" colspan="1">3–4 mg</td><td headers="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_1_2 hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_2_5" valign="top" align="left" rowspan="1" colspan="1">3–4 mg</td><td headers="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_1_2 hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_2_6" valign="top" align="left" rowspan="1" colspan="1">0.5–2 mg</td></tr><tr><td headers="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_1_1" valign="top" align="left" scope="row" rowspan="1" colspan="1">AG</td><td headers="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_1_2 hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_2_1" valign="top" align="left" rowspan="1" colspan="1">5–7mg</td><td headers="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_1_2 hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_2_2" valign="top" align="left" rowspan="1" colspan="1">3–4 mg</td><td headers="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_1_2 hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_2_3" valign="top" align="left" rowspan="1" colspan="1">3–4 mg</td><td headers="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_1_2 hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_2_4" valign="top" align="left" rowspan="1" colspan="1">3–4 mg</td><td headers="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_1_2 hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_2_5" valign="top" align="left" rowspan="1" colspan="1">0.5–2 mg</td><td headers="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_1_2 hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_2_6" valign="top" align="left" rowspan="1" colspan="1">0.5–2 mg</td></tr><tr><td headers="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_1_1" valign="top" align="left" scope="row" rowspan="1" colspan="1">AA</td><td headers="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_1_2 hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_2_1" valign="top" align="left" rowspan="1" colspan="1">3–4 mg</td><td headers="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_1_2 hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_2_2" valign="top" align="left" rowspan="1" colspan="1">3–4 mg</td><td headers="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_1_2 hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_2_3" valign="top" align="left" rowspan="1" colspan="1">0.5–2 mg</td><td headers="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_1_2 hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_2_4" valign="top" align="left" rowspan="1" colspan="1">0.5–2 mg</td><td headers="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_1_2 hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_2_5" valign="top" align="left" rowspan="1" colspan="1">0.5–2 mg</td><td headers="hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_1_2 hd_h_warfarin.T.the_fda_2017_drug_label_for_w_1_1_2_6" valign="top" align="left" rowspan="1" colspan="1">0.5–2 mg</td></tr></tbody></table><p><sup>1</sup>
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The FDA labels specific drug formulations. We have substituted the generic names for any drug labels in this excerpt. The FDA may not have labeled all formulations containing the generic drug. Certain terms, genes and genetic variants may be corrected in accordance to nomenclature standards, where necessary. We have given the full name of abbreviations, shown in square brackets, where necessary.</p></div></div>
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<h2 class="offscreen_noflow">Supplemental Content</h2>
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<div class="portlet_content ln"><ul><li><a href="/gtr/tests?term=C0750384%5bDISCUI%5d&filter=method%3A2%5F8" target="_blank">Deletion/duplication analysis (23)</a></li>
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<li><a href="/gtr/tests?term=C0750384%5bDISCUI%5d&filter=method%3A2%5F17" target="_blank">Mutation scanning of the entire coding region (1)</a></li>
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<li><a href="/gtr/tests?term=C0750384%5bDISCUI%5d&filter=method%3A2%5F9" target="_blank">Sequence analysis of select exons (6)</a></li>
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<li><a href="/gtr/tests?term=C0750384%5bDISCUI%5d&filter=method%3A2%5F7" target="_blank">Sequence analysis of the entire coding region (24)</a></li>
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<li><a href="/gtr/tests?term=C0750384%5bDISCUI%5d&filter=method%3A2%5F19" target="_blank">Targeted variant analysis (35)</a></li>
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<div class="portlet_content ln"><ul class="a_poppers"><li><a target="_blank" href="https://pubmed.ncbi.nlm.nih.gov/?term=(%22warfarin%22%5Btiab%3A~0%5D)%20AND%20(%22english%20and%20humans%22%5BFilter%5D)%20AND%20(%20(%22practice%20guideline%22%5BFilter%5D)%20OR%20(practice*%5Btitl%5D%20AND%20(guideline%5Btitl%5D%20OR%20parameter%5Btitl%5D%20OR%20resource%5Btitl%5D%20OR%20bulletin%5Btitl%5D%20OR%20best%5Btitl%5D))%20OR%20(genetic*%5Btitl%5D%20AND%20(evaluation%5Btitl%5D%20OR%20counseling%5Btitl%5D%20OR%20screening%5Btitl%5D%20OR%20test*%5Btitl%5D))%20OR%20(clinical%5Btitl%5D%20AND%20((expert%5Btitl%5D%20AND%20consensus%5Btitl%5D)%20OR%20utility%5Btitl%5D%20OR%20guideline*%5Btitl%5D))%20OR%20(management%5Btitl%5D%20AND%20(clinical%5Btitl%5D%20OR%20diagnos*%5Btitl%5D%20OR%20recommendation%5Btitl%5D%20OR%20pain%5Btitl%5D%20OR%20surveillance%5Btitl%5D%20OR%20emergency%5Btitl%5D%20OR%20guideline*%5Btitl%5D%20OR%20therap*))%20OR%20(treatment%5Btitl%5D%20AND%20((evaluation%5Btitl%5D%20AND%20diagnosis%5Btitl%5D)%20OR%20(assessment%5Btitl%5D%20AND%20prevention%5Btitl%5D)%20OR%20therap*))%20OR%20(Diagnos*%5Btitl%5D%20AND%20(prenatal%5Btitl%5D%20OR%20treatment%5Btitl%5D%20OR%20follow-up%5Btitl%5D%20OR%20statement%5Btitl%5D%20OR%20criteria%5Btitl%5D%20OR%20newborn%5Btitl%5D%20OR%20differential%5Btitl%5D%20OR%20neonatal%5Btitl%5D%20OR%20neonate%5Btitl%5D))%20OR%20(guideline*%5Btitl%5D%20AND%20(pharmacogenetic*%5Btitl%5D%20OR%20recommendation%5Btitl%5D%20OR%20therap*%5Btitl%5D%20OR%20evidence-based%5Btitl%5D%20OR%20consensus%5Btitl%5D%20OR%20(technical%5Btitl%5D%20AND%20standard*%5Btitl%5D)%20OR%20(molecular%5Btitl%5D%20AND%20testing%5Btitl%5D)))%20OR%20(risk%5Btitl%5D%20AND%20assessment%5Btitl%5D)%20OR%20(recommendation*%5Btitl%5D%20AND%20(statement%5Btitl%5D%20OR%20Evidence-based%5Btitl%5D%20OR%20Consensus%5Btitl%5D))%20OR%20(care%20AND%20((Patient%5Btitl%5D%20AND%20standard*%5Btitl%5D)%20OR%20primary%5Btitl%5D%20OR%20psychosocial%5Btitl%5D))%20OR%20(Health%5Btitl%5D%20AND%20supervision%5Btitl%5D)%20OR%20(statement%5Btitl%5D%20AND%20(policy%5Btitl%5D%20OR%20position%5Btitl%5D%20OR%20Consensus%5Btitl%5D))%20OR%20(pharmacogenetics%5Btitl%5D%20AND%20(Dosing%5Btitl%5D%20OR%20therap*%5Btitl%5D%20OR%20genotype*%5Btitl%5D%20OR%20drug*%5Btitl%5D))%20OR%20(Chemotherapy%5Btitl%5D%20AND%20decision*%5Btitl%5D)%20OR%20(screening%5Btitl%5D%20AND%20(newborn%5Btitl%5D%20OR%20neonat*%5Btitl%5D%20OR%20detection%5Btitl%5D%20OR%20diagnos*%5Btitl%5D))%20OR%20(criteria%5Btitl%5D%20OR%20genotype*%5Btitl%5D)%20)%20NOT%20(%22Case%20reports%22%5BPublication%20type%5D%20OR%20%22clinical%20study%22%5BPublication%20Type%5D%20OR%20%22randomized%20controlled%20trial%22%5BPublication%20Type%5D)" title="PubMed search">PubMed</a><div class="help-popup">See practice and clinical guidelines in PubMed. The search results may include broader topics and may not capture all published guidelines. See the <a href="/medgen/docs/faq/" title="Frequently asked questions" target="_blank">FAQ</a> for details.</div></li></ul><h3 class="subhead">Curated</h3><ul class="a_poppers"><li><a target="_blank" href="https://www.aacc.org/science-and-practice/practice-guidelines/pharmacogenetics">NACB, 2010</a><div>National Academy of Clinical Biochemistry, Clinical practice considerations. In: Laboratory medicine practice guidelines: guidelines and recommendations for laboratory analysis and application of pharmacogenetics to clinical practice, 2010</div></li></ul></div>
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<div class="portlet_content ln"><ul><li><a href="http://www.diseaseinfosearch.org/Warfarin+response/9469" target="_blank">Genetic Alliance</a></li><li><a href="https://www.malacards.org/card/coumarin_resistance" target="_blank">MalaCards</a></li><li><a href="https://vsearch.nlm.nih.gov/vivisimo/cgi-bin/query-meta?v:project=medlineplus&query=Warfarin%20response" target="_blank">MedlinePlus</a></li><li><a href="#" class="jig-ncbipopper results_settings" role="button" aria-expanded="false" aria-haspopup="true" data-jigconfig="triggerPosition : 'bottom center',destPosition : 'top center', hasArrow : false,openEvent : 'click',closeEvent : 'click',isTriggerElementCloseClick: false, addCloseButton : false, groupName: 'entrez_pg',destSelector : '#ghrPopup'">MedlinePlusGenetics (GHR)<span class="tgt_dark"></span></a></li></ul><div id="ghrPopup" aria-live="assertive" aria-hidden="true" style="display: none;" class="portlet_popup tabPopper ui-helper-reset ui-ncbipopper-wrapper ui-ncbipopper-basic"><ul class="column_list"><li><a target="_blank" href="https://medlineplus.gov/genetics/condition/warfarin-resistance">Warfarin resistance</a></li><li><a target="_blank" href="https://medlineplus.gov/genetics/condition/warfarin-sensitivity">Warfarin sensitivity</a></li></ul></div></div>
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<a name="EntrezSystem2.PEntrez.MedGen.MedGen_ResultsPanel.MedGen_SingleItemSuplCluster.MedGenReviews.Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="Reviews" id="EntrezSystem2.PEntrez.MedGen.MedGen_ResultsPanel.MedGen_SingleItemSuplCluster.MedGenReviews.Shutter"></a>
|
||
</div>
|
||
<div class="portlet_content">
|
||
<ul>
|
||
<li>
|
||
<a href="/books/NBK84174" ref="ncbi_uid=&discoId=gtr_reviews&linkpos=1&linkpostotal=5" target="_blank">Medical Genetics Summaries</a>
|
||
</li>
|
||
<li>
|
||
<a href="/pmc/2940214" ref="ncbi_uid=&discoId=gtr_reviews&linkpos=2&linkpostotal=5" target="_blank">PLoS Currents, 2010</a>
|
||
</li>
|
||
<li>
|
||
<a href="/pubmed/clinical?term=Warfarin%20response" ref="ncbi_uid=&discoId=gtr_reviews&linkpos=3&linkpostotal=5" target="_blank">PubMed Clinical Queries</a>
|
||
</li>
|
||
<li>
|
||
<a href="/pubmed/18281915" ref="ncbi_uid=&discoId=gtr_reviews&linkpos=4&linkpostotal=5" target="_blank">Rapid ACCE, 2008</a>
|
||
</li>
|
||
<li>
|
||
<a href="/pubmed?term=Warfarin%20response%20AND%20humans[mesh]%20AND%20review[publication%20type]" ref="ncbi_uid=&discoId=gtr_reviews&linkpos=5&linkpostotal=5" target="_blank">Reviews in PubMed</a>
|
||
</li>
|
||
</ul>
|
||
</div>
|
||
</div>
|
||
|
||
<!-- MedGen supplemental column ends here -->
|
||
<div class="portlet brieflink">
|
||
<div class="portlet_head">
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||
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||
<h3>Related information</h3>
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<div class="portlet_content DiscoveryDbLinks">
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<ul>
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<li class="brieflinkpopper">
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<a class="brieflinkpopperctrl" href="/clinvar?LinkName=medgen_clinvar&from_uid=148193" ref="log$=recordlinks">ClinVar</a>
|
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<div class="brieflinkpop offscreen_noflow">Related medical variations</div>
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</li>
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<li class="brieflinkpopper">
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<a class="brieflinkpopperctrl" href="/gene?LinkName=medgen_gene_diseases&from_uid=148193" ref="log$=recordlinks">Gene</a>
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<div class="brieflinkpop offscreen_noflow">Related information in NCBI Gene</div>
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<a class="brieflinkpopperctrl" href="/mesh?LinkName=medgen_mesh&from_uid=148193" ref="log$=recordlinks">MeSH</a>
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|
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<a class="brieflinkpopperctrl" href="/pubmed?LinkName=medgen_pubmed_bookshelf_cited&from_uid=148193" ref="log$=recordlinks">PubMed (Bookshelf cited)</a>
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<div class="brieflinkpop offscreen_noflow">Links to PubMed based on citations in GeneReviews and Medical Genetics Summaries</div>
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</li>
|
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<li class="brieflinkpopper">
|
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<a class="brieflinkpopperctrl" href="/pubmed?LinkName=medgen_pubmed_omim&from_uid=148193" ref="log$=recordlinks">PubMed (OMIM)</a>
|
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<div class="brieflinkpop offscreen_noflow">Related literature resources in PubMed</div>
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Turn On
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<a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=1" href="/portal/utils/pageresolver.fcgi?recordid=67cd47f884f3725e593dd9d5">Warfarin response</a>
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<a class="htb" ref="log$=activity&linkpos=3" href="/portal/utils/pageresolver.fcgi?recordid=67cd47f4f4a390645e4983ec">C5193019[trait identifier] AND "OMIM"[submitter] <span class="number">(2)</span></a>
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<div class="tertiary">ClinVar</div>
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<a class="htb" ref="log$=activity&linkpos=4" href="/portal/utils/pageresolver.fcgi?recordid=67cd47f384f3725e593db847">C3810265[trait identifier] AND "OMIM"[submitter] <span class="number">(5)</span></a>
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<div class="tertiary">ClinVar</div>
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<a class="htb" ref="log$=activity&linkpos=5" href="/portal/utils/pageresolver.fcgi?recordid=67cd47f2f4a390645e497d25">C3280203[trait identifier] AND "OMIM"[submitter] <span class="number">(5)</span></a>
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<div class="tertiary">ClinVar</div>
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