ArticleEuropean journal of case reports in internal medicine2020
Genetic Warfarin-Resistance Resulting in Surgery to Change a Prosthetic Valve.
Article in European journal of case reports in internal medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed, 6 citations in OpenAlex.
- Challenging Anticoagulation With Warfarin and Heparin Following Mechanical Mitral Valve Replacement in a Patient With Infective Endocarditis: A Case Report Highlighting Diagnostic Difficulties.Clinical case reports · 2026Article
- From warfarin resistance to warfarin overdose: an unusual case report.Drug metabolism and personalized therapy · 2026Article
- VKORC1 polymorphisms and complete resistance to vitamin K antagonists: About two cases.BioMedicine · 2024Article
- A Case of Unexplained Warfarin Resistance: A Case Report and Literature Review.The journal of Tehran Heart Center · 2023Article
- Pharmacogenes that demonstrate high association evidence according to CPIC, DPWG, and PharmGKB.Frontiers in medicine · 2022Article
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Warfarin is a readily available anticoagulant used worldwide in a variety of clinical scenarios. Patients who need more than 15 mg/day are considered to be warfarin resistant. Numerous genes have been implicated in warfarin pharmacogenetics, with genes encoding CYP2C9 and VKORC1 shown to be the most important determinants of drug dosage requirements. A 27-year-old woman was admitted as she had a sub-therapeutic international normalized ratio (INR) after prosthetic mitral valve replacement. Even after a warfarin dose of 50 mg/day, her INR was not in the therapeutic range, so the heart team decided to replace her metallic valve with a bioprosthetic valve, thus alleviating the need for anticoagulation. LEARNING POINTS: Genetic warfarin resistance is rare and mainly associated with two genes encoding CYP2C9 and VKORC1.In addition to dietary counselling and drug compliance, options in warfarin-resistant patients include increasing the warfarin dose, which carries a risk of bleeding complications, or switching to novel oral anticoagulants, which increases the risk of prosthetic valve thrombosis.We replaced a metallic valve with a bioprosthetic valve, which is the first time this has been documented in a patient with warfarin resistance.
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