PHARMACOGENETIC TESTING AS AN ELEMENT OF PERSONALIZED MEDICINE IN REAL CLINICAL PRACTICE

Abstract

Introduction . It has been proven that patients with thrombosis and with a high risk of systemic thromboembolic complications (TEС), including patients with non-valvular atrial fibrillation (AF) should receive effective and safe antithrombotic therapy [1–3]. A personalized approach to prolonged AVK therapy is associated with an improvement in hemostasiological markers of thrombinemia and clinical outcomes in patients with VTE and non-valvular AF [4–8]. Materials and methods . Prospective study was carried out on the basis of the anticoagulant clinic (AC) of the Department of hemostasis and atherothrombosis laboratory of the state budgetary health institution of the Arkhangelsk region “First city clinical hospital named after names E. E. Volosevich” (GBUZ AR FCCH). The object of the study is patients of the AVK registry who applied to the RCATT (n = 107) who underwent pharmacogenetic testing (CYP2C9, CYP4F2, VKORC1 genotype) with calculation of individual doses of warfarin and assessment of quality of life using validated questionnaires. The analysis of the effectiveness and safety of warfarin therapy was carried out. Results . It was found that complications of warfarin therapy developed regardless of the presence of the genotype (CYP2C9, CYP4F2, VKORC1) and the warfarin dosing algorithm under observation in AC. It has been shown that pharmacogenetic testing in patients with VTE and AF is an additional method under the condition of observation in AC. Conclusion . A personalized approach to prolonged VKA therapy using pharmacogenetic testing is appropriate for patients of the older age group, patients with a aggravated hemorrhagic history, frequent minor bleeding at target INR values and the presence of concomitant therapy with cytochrome P450 inhibitors.