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- W1983754008 abstract "Purpose Non-pulsatile axial flow circulatory support (CS) devices require anticoagulation with Warfarin and either single or duel antiplatelet agents to prevent pump thrombosis. Pharmacologic responsiveness to these agents may have significant implications in regards to device management and risk of complications. We studied 26 patients currently on axial flow devices using genetic testing to determine individual responsiveness and metabolism to Warfarin and Clopidogrel. Methods and Materials 26 patients currently on axial flow support for end-stage heart failure had DNA collected using a buccal swab technique. Sensitivity and metabolism to Warfarin and Clopidogrel was determined by identification of the patients’ CYP-2C19, CYP-2C9, and VKORC-1 genotypes. Patients were then categorized by their rate of metabolism of Clopidogrel and Warfarin, and their sensitivity to Warfarin based on their genetic polymorphism. Results Mean patient age was 64.3 ± 10.5 years, and 92.3% were male. 53.8% were bridge to transplantation and 46.2% destination therapy. 10 of the 26 patients (38%) were rapid metabolizers of Clopidogrel and at increased risk of bleeding with normal doses. 6 of the 26 patients (23%) were intermediate metabolizers and would require larger than normal doses to achieve platelet inhibition. 11 of 26 patients (42%) had VKORC1 alleles indicative of low sensitivity to Warfarin and a need for higher doses, and 15% (4/26) high sensitivity and a significantly higher risk of bleeding even with dosage reduction. 31% (8/26) patients had CYP2C9 alleles showing poor or intermediate metabolism of Warfarin and increased risk of bleeding. Conclusions Significant genetic variability exists within the population of patients on CS in regards to sensitivity to Warfarin and Clopidogrel. This variability has potential implications for the reduction of common adverse events such as bleeding or thrombosis, through targeted therapy based on specific genotype." @default.
- W1983754008 created "2016-06-24" @default.
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- W1983754008 date "2013-04-01" @default.
- W1983754008 modified "2023-09-27" @default.
- W1983754008 title "Use of Genetic Testing for Targeted Anticoagulation in Patients on Long-Term Mechanical Circulatory Support" @default.
- W1983754008 doi "https://doi.org/10.1016/j.healun.2013.01.009" @default.
- W1983754008 hasPublicationYear "2013" @default.
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