Pharmaco-genetic testing in patients with atrial fibrillation required oral anticoagulants intake: clinico-economic analysis
The aim of study was to estimate clinical and economical reasonability of routine pharmacogenetic screening in adult out-patients with atrial fibrillation at warfarin appointment. Prospective comparative randomized research included 66 patients with atrial fibrillation who required oral anticoagulants therapy, living in Smolensk region. In pharmacogenetic group warfarin dose was chosen according clinical characteristics, anamnesis and results of genes CYP2C9 and VKORC1 polymorphism research; in control group - according standard criteria without information of patient's genotype. Significant genes CYP2C9 and VKORC1 alleles (CYP2C9*1, CYP2C9*2, CYP2C9*3, VKORC1*1, VKORC1*2) were detected by means of polymerase chain reaction in real-time mode. Among examined population the prevalence (51%) of clinically significant polymorphisms of warfarin sensitivity genotypes (CYP2C9*2, CYP2C9*3, VKORC1*2) was revealed. In pharmacogenetic group we found a decreasing tendency in number of patients with redundant hypocoagulation and more stable international normalized ratio, but differences in comparison with control group were not statistically significant. Factor costs in pharmacogenetic group were significantly higher at a stage of warfarin dose choice; distinctions in direct, indirect and general expenses between groups were not revealed during follow-up supervision.