Warfarin pharmacogenetics: A single VKORC1 polymorphism is predictive of dose across 3 racial groups

Nita A. Limdi, Mia Wadelius, Larisa Cavallari, Niclas Eriksson, Dana C. Crawford, Ming Ta M. Lee, Chien Hsiun Chen, Alison Motsinger-Reif, Hersh Sagreiya, Nianjun Liu, Alan H.B. Wu, Brian F. Gage, Andrea Jorgensen, Munir Pirmohamed, Jae Gook Shin, Guilherme Suarez-Kurtz, Stephen E. Kimmel, Julie A. Johnson, Teri E. Klein, Michael J. Wagner

Research output: Contribution to journalArticlepeer-review

269 Scopus citations

Abstract

Warfarin-dosing algorithms incorporating CYP2C9 and VKORC1 -1639G>A improve dose prediction compared with algorithms based solely on clinical and demographic factors. However, these algorithms better capture dose variability among whites than Asians or blacks. Herein, we evaluate whether other VKORC1 polymorphisms and haplotypes explain additional variation in warfarin dose beyond that explained by VKORC1 -1639G>A among Asians (n = 1103), blacks (n = 670), and whites (n = 3113). Participants were recruited from 11 countries as part of the International Warfarin Pharmacogenetics Consortium effort. Evaluation of the effects of individual VKORC1 single nucleotide polymorphisms (SNPs) and haplotypes on warfarin dose used both univariate and multivariable linear regression. VKORC1 -1639G>A and 1173C>T individually explained the greatest variance in dose in all 3 racial groups. Incorporation of additional VKORC1 SNPs or haplotypes did not further improve dose prediction. VKORC1 explained greater variability in dose among whites than blacks and Asians. Differences in the percentage of variance in dose explained by VKORC1 across race were largely accounted for by the frequency of the -1639A (or 1173T) allele. Thus, clinicians should recognize that, although at a population level, the contribution of VKORC1 toward dose requirements is higher in whites than in nonwhites; genotype predicts similar dose requirements across racial groups.

Original languageEnglish
Pages (from-to)3827-3834
Number of pages8
JournalBlood
Volume115
Issue number18
DOIs
StatePublished - May 6 2010

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