Key result
A urinary concentration of the losartan metabolite E-3174 below 2500 ng/ml predicted a requirement for low warfarin doses (<5 mg/day) with an odds ratio of 20 in patients with artificial heart valves.
Why the study?
Does CYP2C9 activity evaluated via losartan test predict the required warfarin treatment dosage in patients after heart valve replacement?
Observational (n=33)
No
Does CYP2C9 activity evaluated via losartan test predict the required warfarin treatment dosage in patients after heart valve replacement?
Odds Ratio: 20 (95% CI 2.284–175.13)
p-value: p=0.03
The losartan test can help predict the maintenance dose of warfarin in the late postoperative period for patients with prosthetic heart valves, potentially improving the safety of anticoagulation.
May predict low-dose warfarin needs in valve patients; leaves open prospective validation before clinical use.
Aim. To evaluate the influence of gene СYP2C9 activeness via losartan test on the warfarin dosage management in earlier and long-term post-operational periods. Material and methods. Totally 33 patients included with artificial heart valves. All patients underwent assessment of genes carriage by polymorphic marker СYP2C9 by PCR after preparing of DNA from whole blood. The activeness of СYP2C9 was assessed with losartan concentration and its metabolite (E-3174) in urine after single intake of losartan 50 mg. Results. The level of losartan and its active metabolite (E-3174) in urine was a prognostic marker determining therapeutic dose of warfarin in cardiac surgery patients in long-term post-operation period. Conclusion. The СYP2C9 assessment by losartan concentration and E-3174 in“losartan test” might help to determine warfarin treatment dosage in delayed postoperational period that might improve the efficiency and safety of pharmacotherapy in valve prosthesis patients.
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Arslanbekova et al. (2015) conducted an observational in Artificial heart valves requiring warfarin therapy (n=33). Losartan test (urinary E-3174 concentration <2500 ng/ml) vs. Urinary E-3174 concentration >2500 ng/ml was evaluated on Requirement of low warfarin dose (<5 mg/day) in the long-term post-operative period (OR 20, 95% CI 2.284-175.13, p=0.03). A urinary concentration of the losartan metabolite E-3174 below 2500 ng/ml predicted a requirement for low warfarin doses (<5 mg/day) with an odds ratio of 20 in patients with artificial heart valves.
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