Genetic testing to determine anticoagulants dose

A simple genetic test allows doctors to determine the ideal dosage of anticoagulant for individual patients, thus avoiding any bleeding or blood clots during the adjustment period of treatment, according to research published Tuesday.

This clinical study conducted by Medco U.S. medical groups and the Mayo Clinic shows that hospitalizations for all causes, including bleeding and clots, could be reduced by nearly one third simply by testing variations of two genes ( CYP2C9 and VKORCI) that strongly influence a patient's sensitivity to warfarin, a potent anti-coagulant, the most widely prescribed.

Nearly two million people in the United States each year starting treatment with warfarin to prevent blood clots if they suffer from atrial fibrillation - the most common form of cardiac arrhythmia - or after the surgical replacement of a valve of the heart.

"Genetic testing is a tool that physicians can use to determine the beginning of treatment the best dosage of warfarin," said Dr. Robert Epstein, chief medical officer of Medco and director of the Institute's research group, the principal author of the study presented at the annual conference of the American College of Cardiology (ACC) meeting in Atlanta. "Patients can benefit from a suitable mix more quickly and thus have a lower risk of adverse effects," he said.

The sensitivity to warfarin is highly variable, and adjusting the right dosages for each patient can take weeks or months of repeated blood tests.

During this adjustment period of treatment, patients are at high risk of either thrombosis - a clot in a vein resulting from too low a dosage of Warfarin - or hemorrhage in cases of overdose of anti-coagulant.

This study is the first of its kind conducted nationally American. It focused on 896 patients starting treatment in 49 of 50 states.

Shortly after the study participants began taking warfarin, the Mayo Clinic has conducted blood tests of each to determine their genetic susceptibility to anti-coagulant and the results were forwarded to their respective doctors.

During the first six months of testing, patients were genetically tested and were 31% less likely to be hospitalized.

The difference was even more pronounced immediately after the DNA with a 33% reduction in the risk of hospitalization compared to participants not genetically tested.

Reducing the risk to stay at the hospital for bleeding or a blood clot reached 43%, stated the researchers.

"If we reduce the number of hospitalizations to only two for each patient it would suffice to cover the cost of genetic testing that vary from $250 to $400,"  Dr. Epstein said.

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