Abstract | BACKGROUND: For many conditions causing transient ischemic attack or minor stroke, secondary prevention with early initiation of oral anticoagulation is indicated. The individual response to coumarins is known to vary widely and is not well predicted by clinical variables. Patients' discharge from hospital care is often delayed only because the therapeutic target range has not been reached yet. A feasible tool to guide coumarin dosing and thereby safely shortening time in hospital is required. METHODS: RESULTS: Of 49 genotyped patients, 47 were treated in hospital until an international normalized ratio (INR) of 2-3 was reached. The time and the cumulative dose of phenprocoumon necessary to achieve the target INR both were strongly dependent on the individual C283 + 837C -> T genotype (Kruskal-Wallis test p = 0.0002, and p < 0.0001, respectively). Carriers of the TT genotype reached an INR of 2-3 after a mean time of 3.2 days (n = 5), CT carriers after 4.4 days (n = 27), and CC carriers after 6.5 days (n = 15). No other variable, including body weight, was significantly correlated with the treatment response. CONCLUSION: In patients with cerebrovascular disease, genotyping for VKORC1 alone can strongly predict the individual response to de novo phenprocoumon treatment. The size of the pharmacogenetic test's potential effect on a more efficient use of hospital capacities remains to be shown by a controlled interventional study.
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Authors | Marie-Luise Arnold, Caspar Grond-Ginsbach, Manja Kloss, Maria-Teresa Di Mascio, Roland Veltkamp, Peter Ringleb, Christoph Lichy |
Journal | Cerebrovascular diseases (Basel, Switzerland)
(Cerebrovasc Dis)
Vol. 28
Issue 5
Pg. 468-71
( 2009)
ISSN: 1421-9786 [Electronic] Switzerland |
PMID | 19738376
(Publication Type: Journal Article)
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Copyright | Copyright 2009 S. Karger AG, Basel. |
Chemical References |
- Anticoagulants
- Mixed Function Oxygenases
- VKORC1 protein, human
- Vitamin K Epoxide Reductases
- Phenprocoumon
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Topics |
- Aged
- Anticoagulants
(therapeutic use)
- Female
- Genotype
- Humans
- International Normalized Ratio
- Male
- Middle Aged
- Mixed Function Oxygenases
(genetics)
- Pharmacogenetics
- Phenprocoumon
(therapeutic use)
- Precision Medicine
- Stroke
(drug therapy, genetics)
- Vitamin K Epoxide Reductases
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