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Published on: February 28, 2012

An algorithm for managing warfarin resistance.

Olusegun Osinbowale1, Monzr Al Malki, Andrew Schade

  • 1Department of Cardiovascular Medicine, Section of Vascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.

Cleveland Clinic Journal of Medicine
|December 3, 2009
PubMed
Summary
This summary is machine-generated.

Some patients require higher warfarin doses due to resistance, which can be acquired or hereditary. Understanding the genetic basis of warfarin resistance is crucial for effective patient management and treatment.

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Implementation of In Vitro Drug Resistance Assays: Maximizing the Potential for Uncovering Clinically Relevant Resistance Mechanisms
08:46

Implementation of In Vitro Drug Resistance Assays: Maximizing the Potential for Uncovering Clinically Relevant Resistance Mechanisms

Published on: December 9, 2015

Area of Science:

  • Pharmacogenomics
  • Internal Medicine

Background:

  • Warfarin (Coumadin) is a widely used anticoagulant.
  • Achieving and maintaining the therapeutic international normalized ratio (INR) is critical for efficacy and safety.
  • Some patients exhibit warfarin resistance, necessitating higher doses to reach the target INR.

Purpose of the Study:

  • To review the causes of warfarin resistance.
  • To explore the genetic mechanisms underlying warfarin resistance.
  • To propose an evaluation algorithm for patients with suspected warfarin resistance.

Main Methods:

  • Literature review of acquired and hereditary causes of warfarin resistance.
  • Analysis of genetic factors contributing to warfarin resistance.
  • Development of a clinical algorithm for patient assessment.

Main Results:

  • Warfarin resistance can stem from acquired factors like drug/dietary interactions and poor compliance.
  • Hereditary factors also contribute to warfarin resistance, though genetic mechanisms are not fully elucidated.
  • An evaluation algorithm is presented to guide clinicians in assessing patients with suspected warfarin resistance.

Conclusions:

  • Comprehensive evaluation is needed for patients requiring high warfarin doses.
  • Distinguishing between acquired and hereditary causes is important for tailored treatment.
  • Further research into the genetic underpinnings of warfarin resistance is warranted.