Open AccessPhenomenon of unstable international
normalized ratio on warfarin therapy (clinical and genetic aspects).
Author(s) -
Mikhail V. Derugin,
S. F. Zadvorev,
А. Г. Обрезан,
Alexander É. Filippov,
С Л Гришаев
Publication year - 2018
Publication title -
kliničeskaâ medicina
Language(s) - English
Resource type - Journals
eISSN - 2412-1339
pISSN - 0023-2149
DOI - 10.18821/0023-2149-2018-96-1-42-48
Subject(s) - warfarin , medicine , oral anticoagulant , vitamin k , intensive care medicine , clinical practice , scale (ratio) , physical therapy , atrial fibrillation , physics , quantum mechanics
One of the most important problems in the modern coagulation is the issue of choosing the optimal drug for a long-term oral anticoagulation therapy. Research results of the last 5-10 years show that the reasonable choice between vitamin K antagonists (VKA) and non-vitamin K-dependent oral anticoagulants (NOAC) can be made. The following article describes the phenomenon of «labile INR» on warfarin therapy and describes its clinic and hereditary determinants. Our data about the clinical testing toassess the risk of "labile INR" based on the scale of the Russian populat ion demonstrate potential benefits from setting the scale into the clinic. It is shown that Clinical SAMe-TT2R2 scale correlates with the duration of achieving the target INR, and the patients with the SAMe-TT2R2 score of 4 or more are in the group of iatrogenic complications risks. The contribution of genetic and clinical factors to INR dynamics at the start of therapy in different groups of patients, according to their sensitivity to warfarin therapy and potential duration, is discussed in the article. The results obtained by the analysis of «labile INR» factors will help a doctor to make a choice of anticoagulant between the NOAC and VKA.