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首页> 外文期刊>Clinica chimica acta: International journal of clinical chemistry and applied molecular biology >Standard warfarin dose in a patient with the CYP2C9*3/*3 genotype leads to hematuria.
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Standard warfarin dose in a patient with the CYP2C9*3/*3 genotype leads to hematuria.

机译：CYP2C9 * 3 / * 3基因型患者的标准华法林剂量会导致血尿。

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摘要

BACKGROUND: Patients with certain CYP2C9 genetic variants have increased sensitivity to warfarin and are at increased risk of over-coagulation with standard warfarin dose. We report over-anticoagulation and hematuria manifest as a slow increase in the international normalized ratio (INR) due to warfarin treatment in a patient with the CYP2C9*3/*3 allele. CASE: A 58-y-old man with paroxysmal atrial fibrillation received a standard warfarin dose of 2.0mg/day. Because INR was 2.00 one week after treatment initiation, he was discharged from the hospital. One month later, hematuria was present and INR had increased to 7.26. Although in normal cases (R)-warfarin plasma concentrations are higher than (S)-warfarin, this patient had the opposite warfarin enantiomer plasma concentration profile. CONCLUSIONS: Increased anticoagulation was due to an increased concentration of (S)-warfarin, the more active warfarin enantiomer. INR response to warfarin in this CYP2C9*3/*3 patient was slow. The later INR response appears to be strongly affected by CYP2C9 variants. He also had the VKORC1 -1639G>A AA genotype, requiring a lower warfarin dose. In this case, increased risk of bleeding could have been identified by prospective genotyping of CYP2C9 and VKORC1 prior to initiating warfarin therapy.
机译：背景：具有某些CYP2C9基因变异的患者对华法令的敏感性增加，并且在标准华法令剂量下发生过度凝结的风险增加。我们报告过度抗凝和血尿表现为由于华法林治疗CYP2C9 * 3 / * 3等位基因患者的国际标准化比率（INR）缓慢增加。病例：一名阵发性房颤的58岁男性接受标准华法林剂量2.0毫克/天。由于治疗开始后一周INR为2.00，因此他已出院。一个月后，出现血尿，INR增加至7.26。尽管在正常情况下（R）-华法林血浆浓度高于（S）-华法林，但该患者的华法林对映体血浆浓度却相反。结论：增加的抗凝作用是由于（S）-华法林（一种更活跃的华法林对映体）的浓度增加。该CYP2C9 * 3 / * 3患者对华法令的INR反应缓慢。后来的INR应答似乎受到CYP2C9变异的强烈影响。他还具有VKORC1 -1639G> AA AA基因型，需要较低的华法林剂量。在这种情况下，可以通过在开始华法林治疗之前对CYP2C9和VKORC1进行前瞻性基因分型来确定出血风险增加。

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