Warfarin Toxicity and Individual Variability—Clinical Case

Warfarin is a widely used anticoagulant in the treatment and prevention of thrombosis, in the treatment for chronic atrial fibrillation, mechanical valves, pulmonary embolism, and dilated cardiomyopathy. It is tasteless and colorless, was used as a poison, and is still marketed as a pesticide agains...

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Main Authors: Steven Boyages, Colin Rochester, Trudi Jones, Irina Piatkov
Format: Article
Language:English
Published: MDPI AG 2010-10-01
Series:Toxins
Subjects:
Online Access:http://www.mdpi.com/2072-6651/2/11/2584/
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author Steven Boyages
Colin Rochester
Trudi Jones
Irina Piatkov
author_facet Steven Boyages
Colin Rochester
Trudi Jones
Irina Piatkov
author_sort Steven Boyages
collection DOAJ
description Warfarin is a widely used anticoagulant in the treatment and prevention of thrombosis, in the treatment for chronic atrial fibrillation, mechanical valves, pulmonary embolism, and dilated cardiomyopathy. It is tasteless and colorless, was used as a poison, and is still marketed as a pesticide against rats and mice. Several long-acting warfarin derivatives—superwarfarin anticoagulants—such as brodifacoum, diphenadione, chlorophacinone, bromadiolone, are used as pesticides and can produce profound and prolonged anticoagulation. Several factors increase the risk of warfarin toxicity. However, polymorphisms in cytochrome P450 genes and drug interactions account for most of the risk for toxicity complications. Each person is unique in their degree of susceptibility to toxic agents. The toxicity interpretation and the health risk of most toxic substances are a subject of uncertainty. Genetically determined low metabolic capacity in an individual can dramatically alter the toxin and metabolite levels from those normally expected, which is crucial for drugs with a narrow therapeutic index, like warfarin. Personalized approaches in interpretation have the potential to remove some of the scientific uncertainties in toxicity cases.
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spelling doaj.art-a08559e6a2ec430994d37e67dd60d8cb2022-12-22T03:59:43ZengMDPI AGToxins2072-66512010-10-012112584259210.3390/toxins2112584Warfarin Toxicity and Individual Variability—Clinical CaseSteven BoyagesColin RochesterTrudi JonesIrina PiatkovWarfarin is a widely used anticoagulant in the treatment and prevention of thrombosis, in the treatment for chronic atrial fibrillation, mechanical valves, pulmonary embolism, and dilated cardiomyopathy. It is tasteless and colorless, was used as a poison, and is still marketed as a pesticide against rats and mice. Several long-acting warfarin derivatives—superwarfarin anticoagulants—such as brodifacoum, diphenadione, chlorophacinone, bromadiolone, are used as pesticides and can produce profound and prolonged anticoagulation. Several factors increase the risk of warfarin toxicity. However, polymorphisms in cytochrome P450 genes and drug interactions account for most of the risk for toxicity complications. Each person is unique in their degree of susceptibility to toxic agents. The toxicity interpretation and the health risk of most toxic substances are a subject of uncertainty. Genetically determined low metabolic capacity in an individual can dramatically alter the toxin and metabolite levels from those normally expected, which is crucial for drugs with a narrow therapeutic index, like warfarin. Personalized approaches in interpretation have the potential to remove some of the scientific uncertainties in toxicity cases.http://www.mdpi.com/2072-6651/2/11/2584/warfarinpesticidesanticoagulant
spellingShingle Steven Boyages
Colin Rochester
Trudi Jones
Irina Piatkov
Warfarin Toxicity and Individual Variability—Clinical Case
Toxins
warfarin
pesticides
anticoagulant
title Warfarin Toxicity and Individual Variability—Clinical Case
title_full Warfarin Toxicity and Individual Variability—Clinical Case
title_fullStr Warfarin Toxicity and Individual Variability—Clinical Case
title_full_unstemmed Warfarin Toxicity and Individual Variability—Clinical Case
title_short Warfarin Toxicity and Individual Variability—Clinical Case
title_sort warfarin toxicity and individual variability clinical case
topic warfarin
pesticides
anticoagulant
url http://www.mdpi.com/2072-6651/2/11/2584/
work_keys_str_mv AT stevenboyages warfarintoxicityandindividualvariabilityclinicalcase
AT colinrochester warfarintoxicityandindividualvariabilityclinicalcase
AT trudijones warfarintoxicityandindividualvariabilityclinicalcase
AT irinapiatkov warfarintoxicityandindividualvariabilityclinicalcase