Influence of CYP2C9 and VKORC1 gene variants on warfarin response in Kazakhstani patients with left ventricular assist devices

Abstract

Heart failure is a worldwide epidemic affecting approximately 23 million people globally and is a major burden for the healthcare system [1,2]. Despite advances in medical therapy, the disease is progressive and a significant proportion of patients will need advanced heart replacement therapy. Left ventricular assist devices (LVAD) are an invaluable part of the therapeutic measures for patients suffering from advanced heart failure. When used either as a bridge to transplant, to promote myocardial recovery, or as lifetime use, LVADs have proven to prolong survival and improve quality of life [1-3]. In spite of their success in improving mortality and quality of life, thrombotic and bleeding events remain significant complications [1]. Achieving therapeutic anticoagulation efficiently with warfarin is important to reduce thrombotic and bleeding risks and is influenced by genotype. Warfarin has a narrow therapeutic index and displays marked person-to-person variation in dose requirement. Functional polymorphisms at candidate genes can therefore offer utility as biomarkers to individualize warfarin treatment.