Clinical Chemistry
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Clinical Chemistry 55: 709-711, 2009. First published January 30, 2009; 10.1373/clinchem.2008.115964
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(Clinical Chemistry. 2009;55:709-711.)
© 2009 American Association for Clinical Chemistry, Inc.

Point/Counterpoint

Point: Use of Pharmacogenetics in Guiding Treatment with Warfarin

Mia Wadelius1,a

1 Department of Medical Sciences, Clinical Pharmacology, Uppsala University Hospital, Uppsala, Sweden.

aAddress correspondence to the author at: Clinical Pharmacology, Uppsala University Hospital, Entrance 61, 3rd Floor, Uppsala, NA, Sweden SE-75185. Fax +46-18-6113703; e-mail mia.wadelius@medsci.uu.se.

The first 20% of the full text of this article appears below.

Warfarin is the most widely used oral anticoagulant for the treatment of thromboembolic disorders and for stroke prophylaxis. Warfarin is a problematic drug because it exhibits large interindividual variation in the required therapeutic dose, has a narrow therapeutic range, and shows multiple food and drug interactions. Its anticoagulant effect is monitored by measuring the international normalized ratio (INR), which is a function of the time required for a patient’s blood to coagulate relative to the time it takes for a reference blood sample. Although warfarin has been used in humans for more than 50 years, its main side effect—bleeding—is a leading cause of hospital admission and drug-related death(1)(2). This problem has made patients and clinicians yearn for a new efficient and safe oral anticoagulant drug that does not require frequent monitoring. In Europe, a new oral anticoagulant drug (dabigatran) claimed to have these qualities has been licensed for short-term primary prevention of venous thromboembolic events, but its effectiveness in long-term secondary thromboprophylaxis remains to be shown. Furthermore, the daily cost of dabigatran is 5 times that of warfarin therapy including INR tests. To switch all warfarin patients (currently 1% of the population in many Western countries) to dabigatran would boost . . . [Full Text of this Article]






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