Warfarin Resisance and Recurrent Thrombosis in an Iranian Patient
Abstract
Warfarin resisance was known as subtherapeutic INR (International Normalized Ratio) in spite of normally prescribed doses of warfarin. There are few reports of warfarin resisance from Iran. In this article, we report a 43-year-old man with a hisory of deep vein thrombosis who took 10 mg of warfarin and 120 mg of enoxaparin daily. He was presented with new acute deep vein thrombosis while taking anticoagulants. Despite warfarin dose increase to 50 mg, the INR did not achieve the therapeutic level. His genetic tesing was negative for VKORC1 mutation but positive for CYP2C9*3, which proposed other underlying mechanisms for his warfarin resisance. This report added to the cases of warfarin resisance in Iran and herald more attention to warfarin metabolism and its interaction. Also it calls for checking serum warfarin level and Factor II and Factor X level for better evaluating compliance in patients presented with warfarin resistance.
[2] de Oliveira Almeida VC, Ribeiro DD, Gomes KB, Godard AL. Polymorphisms of CYP2C9, VKORC1, MDR1, APOE and UGT1A1 genes and the therapeutic warfarin dose in Brazilian patients with thrombosis: A prospective cohort study. Molecular Diagnosis & Therapy. 2014; 18(6):675-83. [DOI:10.1007/ s40291-014-0121-4] [PMID]
[3] Yuan SM. Warfarin use and dose adjustment in a patient with mitral valve replacement. Pakistan Journal of Pharmaceutical Sciences. 2015; 28(4):1351-5. [PMID]
[4] Sattar A, Willman JE, Kolluri R. Possible warfarin resistance due to interaction with ascorbic acid: Case report and literature review. American Journal of Health-System Pharmacy. 2013; 70(9):782-6. [DOI:10.2146/ajhp110704] [PMID]
[5] Nishimura F, Tokuda M, Sasaki D, Mori S, Tsuruda K, Hasegawa H, et al. An instructive case suggesting warfarin
resistance which is independent on the regulation of the CYP2C9 and VKORC1 genotype. Rinsho Byori. 2011; 59(12):1087- 90. [PMID]
[6] Mega JL, Simon T. Pharmacology of antithrombotic drugs: An assessment of oral antiplatelet and anticoagulant treatments. Lancet. 2015; 386(9990):281-91. [DOI:10.1016/S0140- 6736(15)60243-4]
[7] Ghadam P, Sadeghian F, Sharifian R, Sardrai S, Kazemi B, Nematpour E. VKORC1 gene analysis in an warfarin resistant
Iranian patient. Journal of Bioogical Sciences. 2008; 8(3):691-2. [DOI:10.3923/jbs.2008.691.692]
[8] Sadrai S, Ghadam P, Sharifian R, Sadeghian F. Assaying of warfarin in Iranian warfarin resistance patients blood by HPLC. Pakistan Journal of Biological Sciences. 2008; 11(4):683- 5. [DOI:10.3923/pjbs.2008.683.685] [PMID]
[9] Dumo PA, Kielbasa LA. Successful anticoagulation and continuation of tramadol therapy in the setting of a tramadolwarfarin interaction. Pharmacotherapy. 2006; 26(11):1654-7. [DOI:10.1592/phco.26.11.1654] [PMID]
[10] Sabbe JR, Sims PJ, Sims MH. Tramadol-warfarin interaction. Pharmacotherapy. 1998; 18(4):871-3. [PMID]
[11] Pottegard A, dePont Christensen R, Wang SV, Gagne JJ, Larsen TB, Hallas J. Pharmacoepidemiological assessment of drug interactions with vitamin K antagonists. Pharmacoepidemiology and Drug Safety. 2014; 23(11):1160-7. [DOI:10.1002/pds.3714] [PMID]
[12] Wood MD, Delate T, Clark M, Clark N, Horn JR, Witt DM. An evaluation of the potential drug interaction between warfarin and levothyroxine. Journal of Thrombosis and Haemostasis. 2014; 12(8):1313-9. [DOI:10.1111/jth.12626] [PMID]
[13] Kimmel SE. Warfarin pharmacogenomics: Current best evidence. Journal of Thrombosis and Haemostasis. 2015; 13(Suppl 1):S266-71. [PMID]
[14] Poopak B, Rabieipoor S, Safari N, Naraghi E, Sheikhsofla F, Khosravipoor G. Identification of CYP2C9 and VKORC1 polymorphisms in Iranian patients who are under warfarin therapy. International Journal of Hematology-oncology and Stem Cell Research. 2015; 9(4):185-92. [PMID] [PMCID]
| Files | ||
| Issue | Vol 3 No 3 (2018): Summer | |
| Section | Case Report(s) | |
| Keywords | ||
| Warfarin resistance Iran | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
