The effectiveness of treatment with oral anticoagulants
in the prevention of thrombotic disorders is well established,
but these drugs are potentially dangerous because of their
narrow therapeutic index. In Europe three coumarins are used:
warfarin, acenocoumarol, and phenprocoumon. Genetic factors that
have been recently demonstrated to change the pharmacokinetics
and pharmacodynamics of coumarins are the presence of
polymorphisms in the genes encoding for CYP2C9 and VKOR (vitamin
K epoxide reductase complex). Polymorphisms in these genes are
associated with increased risk for severe overanticoagulation
and bleedings.
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