Other Drugs

Antiplatelet (e.g., aspirin) and anticoagulant (e.g., warfarin) agents are commonly used to prevent and treat cardiovascular thrombolic events. Several genetic polymorphisms have been identified in the coagulation F5 and F7 genes. The G1691A variant in the F5 gene and the G20210A variant in the prothrombin (F2) gene are established risk factors for venous thrombosis. In women who carried the prothrombin variant and were on oral contraceptives, the OR rose from 10.2 to 149. The relative risk was sixfold higher for prothrombin A20210 variant and ninefold higher for F5 A1691 carriers (184) in deep vein thrombosis patients. There is also evidence that the F5 genotype is directly correlated with prothrombotic phenotype and anticoagulant/antiplatelet treatment. However, the treatment that is currently available is not ideal, in that warfarin requires regular monitoring and lowers natural anticoagulant levels and also procoagulant factors. This is likely to change soon with the introduction of orally active direct thrombin inhibitors, such as ximelagatran. The effects of the anticoagulant "warfarin" are discussed in detail in the relevant chapter on hematological aspects of pharmacogenetics.

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