Guiding value of VKORC1 and CYP2C9 gene polymorphisms on anticoagulation treatment of warfarin in ICU patients
YAN Bin1, ZHANG Mei2, ZHAO Guifeng1
1. Department of Intensive Care Unit, 2. Department of Gynecology and Obstetrics, Characteristics Medical Center of PLA Rocket Force, Beijing 100088, China
Abstract：Objective To investigate the guiding value of vitamin K epoxide reductase complex subunit 1 (VKORC1) and cytochrome oxidase P450 2C9 (CYP2C9) gene polymorphism detection on anticoagulation therapy of warfarin in intensive care unit (ICU) patients. Methods Ninety patients with indication of anticoagulation (atrial fibrillation, deep vein thrombosis and pulmonary embolism) admitted to ICU of Characteristics Medical Center of PLA Rocket Force from June 2019 to June 2023 were retrospectively analyzed. The study group (30 cases) underwent genetic testing and were instructed to use warfarin based on the test results, while the control group (60 cases) implemented the conventional clinical warfarin medication strategy without genetic testing. Both groups were followed up for 6 months. The general clinical data, genotype distribution of the study group, INR attainment time, time in treatment range TTR, warfarin starting dose, maintenance dose, incidence of bleeding events and incidence of INR ≥ 4.0 events were compared between the two groups. Results The time to achieve INR in the study group was (9.56±1.68) d, which was significantly shorter than that in the control group (11.12±2.03) d, P<0.05. The TTR in the study group was (72.56±6.90) %, which was higher than that in the control group (64.45±7.82) %, P<0.05. The starting and maintenance doses of warfarin in the study group were (2.91±0.73) mg/d and (3.17±0.81) mg/d, respectively, which were not statistically different from those in the control group (P>0.05). There were six cases (20.00%) of small bleeding events in the study group, which was significantly lower than that in the control group (twenty-seven cases, 45.00%, P<0.05). In contrast, there was no significant difference in the incidence of major bleeding events between the two groups (P>0.05). The incidence of INR≥4.0 in the study group was 16.67%, significantly lower than that in the control group (40.00%, P<0.05). Conclusions Detection of VKORC1 and CYP2C9 polymorphisms in ICU patients with indication of anticoagulation is beneficial to enhance anticoagulation efficacy, reduce related adverse reactions, and improve drug safety.
闫斌, 张梅, 赵贵锋. VKORC1和CYP2C9基因多态性对ICU患者华法林抗凝治疗的指导价值[J]. 武警医学, 2024, 35(10): 853-856.
YAN Bin, ZHANG Mei, ZHAO Guifeng. Guiding value of VKORC1 and CYP2C9 gene polymorphisms on anticoagulation treatment of warfarin in ICU patients. Med. J. Chin. Peop. Armed Poli. Forc., 2024, 35(10): 853-856.
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2024, Vol. 35 
