Exploring the Influence of Pharmacogenetic Variability on Warfarin Treatment Outcomes

Pharmacogenetics holds much promise for influence on warfarin dose initiation. It is a science that is still in its relative infancy but has already achieved success in this area. To appreciate fully whether pharmacogenetics can provide the long-sought solution, it is necessary to understand the genetic and environmental factors that determine warfarin dose requirement and how they are involved in dose prediction. (Al-Eitan et al.2021) The degree of interindividual variability in warfarin dose requirement is considerably higher than for most other drugs. If clinical or genetic information could be used to predict the correct warfarin dose, then each individual could potentially be given a much more appropriate starting dose when warfarin treatment is initiated.( Wadelius M, et al. 2007) Although it is now more than half a century since warfarin was first used clinically, the problem of how to initiate it safely and efficaciously still poses a difficult challenge. Over-anticoagulation can lead to serious or fatal bleeding events; under-anticoagulation can lead to thromboembolism. Both events are most keenly avoided. If warfarin dose could be predicted and the desired therapeutic range achieved early in treatment, treatment decisions would be much easier for both doctor and patient. (Ansell J, Hirsh J, Hylek E, et al. 2008).