The impact of R353Q genetic polymorphism in coagulation factor VII on the initial anticoagulant effect exerted by warfarin

Background The initial rise in INR following warfarin is attributed to rapid decline in coagulation factor VII (F7). The R353Q polymorphism in F7 accounts for approximately 1/3 of the variability in F7 activity (FVIIc). Objective Evaluate the role of R353Q in the initial response to warfarin. Methods Twenty-eight healthy, males, carrying CYP2C9*1/*1 ( n = 14), CYP2C9*1/*2 ( n = 4) or CYP2C9*1/*3 ( n = 10) genotypes, received single 20 mg warfarin. S&R- warfarin concentrations, INR, and FVIIc were monitored periodically for 7 days. Results Baseline and maximal INR were 5.6% and 33.5% higher among carriers of the RQ ( n = 12) as compared with those carrying the RR ( n = 16) genotype ( p = 0.032, p = 0.003, respectively). Baseline and nadir FVIIc were 21.6% and 42.0% lower among subjects carrying the RQ as compared with carriers of the RR genotype ( p = 0.001, p = 0.007 respectively). In multiple regression analysis, R353Q predicted 36.6% of the variability in peak INR whereas 20.2%, 9.9%, and 5.9% were attributed to VKORC1 genetic polymorphism, cholesterol concentration, and S Warfarin concentration after 24 h, respectively. Conclusions R353Q genetic polymorphism plays a key role in determining the initial response to warfarin. The incorporation of this genetic variant into warfarin loading algorithm should be further investigated.