Warfarin and vitamin K intake in the era of pharmacogenetics
Article first published online: 22 MAR 2010
© 2010 The Authors. Journal compilation © 2010 The British Pharmacological Society
British Journal of Clinical Pharmacology
Volume 70, Issue 2, pages 164–170, August 2010
How to Cite
Lurie, Y., Loebstein, R., Kurnik, D., Almog, S. and Halkin, H. (2010), Warfarin and vitamin K intake in the era of pharmacogenetics. British Journal of Clinical Pharmacology, 70: 164–170. doi: 10.1111/j.1365-2125.2010.03672.x
- Issue published online: 9 JUL 2010
- Article first published online: 22 MAR 2010
- Received 8 November 2009Accepted12 March 2010
- vitamin K;
The considerable variability in the warfarin dose–response relationship between individuals, is explained mainly by genetic variation in its major metabolic (CYP2C9) and target (VKORC1) enzymes. Despite the predominance of pharmacogenetics, environmental factors also affect the pharmacokinetics and pharmacodynamics of warfarin, and are often overlooked. Among these factors, dietary and supplemental vitamin K consumption is a controllable contributor to within-, and between-patient variability of warfarin sensitivity. In this commentary we review the current role of vitamin K in warfarin anticoagulation therapy, with emphasis on the following:
1 The effect of dietary and supplemental vitamin K on warfarin anticoagulation, beyond the impact of genetic variability in CYP2C9 and VKORC1. We deal separately with the effects of vitamin K on warfarin dose requirements during the induction of therapy, as opposed to its effect on stability of anticoagulation control during maintenance therapy.
2 The role of vitamin K supplementation in warfarin treated patients with vitamin K deficiency as well as in patients with unstable warfarin anticoagulation, and
3 The role of therapeutic vitamin K in cases of warfarin over-anticoagulation.