ВОЗМОЖНОСТИ ИСПОЛЬЗОВАНИЯ ФАРМАКОГЕНЕТИЧЕСКОГО ПОДХОДА ДЛЯ КОРРЕКЦИИ АНТИКОАГУЛЯНТНОЙ ТЕРАПИИ У БОЛЬНЫХ С ПРОТЕЗАМИ КЛАПАНОВ СЕРДЦА

Aim. To compare the effectiveness of various pharmacogenetics algorithms of warfarin dosage and to identify the strengths and limitations of standard genetic tests for the warfarin dose correction during the late postoperative period among 134 warfarin-treated patients with prosthetic heart valves. Material and methods. All patients underwent genotyping for the CYP2C9 gene polymorphisms (CYP2C9*2 (С430Т) and CYP2C9*3 (А1075C) and for the vitamin K epoxide reductase complex subunit 1 VKORC1 (G-1639A). To compare the empirical and calculated warfarin doses, formulas by Gadge BF et al., Sconce EA et al., Anderson JL et al., and Takahashi H et al. were used. Results. In 54 (40%) patients with adequate levels of international normalised ratio (INR; 2,0–3,0), empirical warfarin doses were the closest to the doses calculated using the formula by Gadge BF et al. In 49 (37%) patients with 2>INR>3, there was a mismatch between empirical and calculated warfarin doses, while in 31 (23%) patients, the pharmacogenetics algorithm of choice was inadequate. Conclusion. The algorithm by Gadge BF et al. should be the first option in the process of choosing and/or correcting the dosage of warfarin. Additional pharmacogenetics algorithms require further improvement.