Warfarin Sensitivity Genotyping

Warfarin Metabolism

August 2008

There are two isomers of warfarin as I indicated earlier; the less active R-warfarin is metabolized as by a variety of cytochrome P450 enzymes encoded by several different CYP genes. These hydroxylate the R-warfarin derivatives, and then it is eliminated.

The S-warfarin, or the more active isomer, is metabolized predominately made by CYP2C9 enzyme which is encoded by the CYP2C9 gene. This hydroxylates the S-warfarin and it is also eliminated.

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Warfarin Metabolism

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Jump to section:

• Introduction
• Warfarin
• Warfarin Anticoagulation
• Warfarin
• Warfarin Monitoring
• Therapeutic Graph
• INR Variability in a 74 Year-old Male
• Warfarin and Bleeding Events
• Warfarin Metabolism
• Polymorphisms and Warfarin Sensitivity
• Polymorphisms and Warfarin Sensitivity
• Summary of Polymorphisms and Warfarin Pharmacokinetics⁵
• CYP2C9 Association Study
• PGx-Guided Warfarin Dosing⁷
• Warfarin Pharmacodynamics
• Polymorphisms and Warfarin Sensitivity
• VKORC1 Promoter Polymorphism⁶
• CYP2C9 and VKORC1 Interaction⁸
• Genotype-guided Warfarin Dosing⁹
• Genotype-guided Dosing
• Summary
• Orthopedic Algorithm¹⁰
• Significant Warfarin Drug Interactions
• Differential Effect of Drugs
• Patient Case: Rapidly Increasing INR
• References
• Questions?