Variability of warfarin dose response associated with CYP2C9 and VKORC1 gene polymorphisms in Chinese patients

J Int Med Res. 2014 Feb;42(1):67-76. doi: 10.1177/0300060513499094. Epub 2013 Nov 28.

Abstract

Objective: To investigate the prevalence and implication of cytochrome P450, family 2, subfamily C, polypeptide 9 (CYP2C9) variants and vitamin K epoxide reductase complex, subunit 1 (VKORC1)-1639 G > A polymorphisms in Chinese patients receiving warfarin therapy.

Methods: Chinese Han patients requiring oral warfarin therapy were consecutively enrolled. Correlations between CYP2C9*1, *2, *3, *4, *5 variants and VKORC1-1639 G > A polymorphisms, fourth-day international normalized ratios (INRs) and warfarin maintenance dose were investigated.

Results: Out of 101 patients, there were no significant differences in fourth-day INR or warfarin daily maintenance doses between patients with CYP2C9*1*1 and CYP2C9*1*3 genotypes. Patients with the VKORC1-1639 AA genotype had a higher fourth-day INR (1.87 ± 0.14) than those with the VKORC1-1639 AG genotype (1.32 ± 0.15). Warfarin maintenance dose for patients with the VKORC1-1639 AA genotype (2.40 ± 0.70 mg/day) was significantly lower than for patients with the VKORC1-1639 AG genotype (4.83 ± 0.70 mg/day).

Conclusions: Unlike Caucasian populations, VKORC1-1639 G > A polymorphisms in the Chinese population may be the dominant genetic factors associated with warfarin response variability.

Keywords: Warfarin; cytochrome P450; family 2; international normalized ratio (INR); polypeptide 9 (CYP2C9); single nucleotide polymorphism; subfamily C; subunit 1 (VKORC1); vitamin K epoxide reductase complex.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Anticoagulants / administration & dosage
  • Anticoagulants / therapeutic use*
  • Aryl Hydrocarbon Hydroxylases / genetics*
  • Base Sequence
  • China
  • Cytochrome P-450 CYP2C9
  • DNA Primers
  • Dose-Response Relationship, Drug
  • Ethnicity
  • Female
  • Humans
  • International Normalized Ratio
  • Male
  • Middle Aged
  • Polymorphism, Genetic*
  • Vitamin K Epoxide Reductases / genetics*
  • Warfarin / administration & dosage
  • Warfarin / therapeutic use*
  • Young Adult

Substances

  • Anticoagulants
  • DNA Primers
  • Warfarin
  • CYP2C9 protein, human
  • Cytochrome P-450 CYP2C9
  • Aryl Hydrocarbon Hydroxylases
  • VKORC1 protein, human
  • Vitamin K Epoxide Reductases