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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：标准华法林剂量在患者中，CYP2C9 * 3 / * 3基因型导致血尿。

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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：某些CYP2C9遗传变体的患者对华法林的敏感性增加，并且具有较高的凝结风险，具有标准的华法林剂量。由于CYP2C9 * 3 / * 3等位基因的患者在患者中，我们报告过抗凝和血尿表现为国际标准化比率的缓慢增加（INR）。案例：一个58 y老人，阵发性心房颤动接受了2.0mg /天的标准华法林剂量。因为inr是在治疗开始后一周的2.00，他从医院出院。一个月后，血尿存在，inr增加到7.26。虽然在正常情况下（R）-warfarin血浆浓度高于（s）-warfarin，但该患者具有相反的华法林对映体血浆浓度曲线。结论：抗凝率增加是由于（S）-Warfarin的浓度增加，更活跃的华法林对映体。在此CYP2C9 * 3 / * 3患者中对Warfarin的反应是慢的。稍后的INR响应似乎受CYP2C9变体强烈影响。他还有VKORC1 -1639G> AA基因型，需要较低的华法林剂量。在这种情况下，可以通过在启动华法林治疗之前通过CYP2C9和VKORC1的预期基因分型来鉴定出血风险。

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