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Aim. To evaluate adherence to treatment, mutations of the hemostatic system and food preferences as predictors of choice of optimal anticoagulant therapy in patients with atrial fibrillation (AF).

Material and methods. 142 patients with AF were quantitatively evaluated in terms of their adherence to treatment, polymorphism of genes CYP2C9 and VKORC1 and the structure of food preferences.

Results. Persons with insufficient adherence to treatment prevailed among AF patients, at that the leading negative factor was the low adherence to medical support, which directly related with the frequency of complications and ineffectiveness of anticoagulant therapy. The very high prevalence of gene mutations CYP2C9 and VKORC1 (more than 2.3 per 1 respondent) was detected in the study sample, which makes screening pharmacogenetic testing ineffective and is an independent risk factor for the Omsk region. Consumption by the population of food products that can affect anticoagulant therapy with warfarin does not have special regional characteristics and does not differ significantly among respondents both without AF and with AF (99.2±41.9 vs 100.8±38.6 points; р=0.82) as well as among patients with AF both taking and not taking warfarin (85.4±47.0 vs 107.3±42.1 points, p=0.9).

Conclusion. Individualized choice of anticoagulant in patients with AF should be based on a structured quantitative assessment of adherence to treatment. In low adherence to treatment and choice of warfarin as an anticoagulant, its safety should be confirmed by the assessment of pharmacogenetic status and/or dietary preferences of the patient.

About the Authors

Ju. P. Skirdenko
Omsk State Medical University
Russian Federation

Julia P. Skirdenko – MD, Assistant, Chair of Faculty Therapy, Occupational Diseases 

Lenina ul. 12, Omsk, 644099

N. A. Nikolayev
Omsk State Medical University
Russian Federation

Nikolay A. Nikolayev – MD, PhD, Professor, Chair of Faculty Therapy, Occupational Diseases 

Lenina ul. 12, Omsk, 644099


1. Diagnosis and treatment of atrial fibrillation. Clinical recommendations, 2017. Available at: Checked by 01/22/2018 (In Russ.) [Диагностика и лечение фибрилляции предсердий. Клинические рекомендации, 2017. Доступно на: Проверено 22.01.2018].

2. Poopak B, Rabieipoor S, Safari N, et al. Identification of CYP2C9 and VKORC1 polymorphisms in Iranian patients who are under warfarin therapy. Int J Hematol Oncol Stem Cell Res. 2015;9(4):185-92.

3. Tatsumi A., Kadobayashi M., Iwakawa S. Effect of Ethanol on the Binding of Warfarin Enantiomers to Human Serum Albumin. Biol Pharm Bull. 2007;30(4):826-9. doi: 10.1248/bpb.30.826.

4. Mellen CK, Ford M, Rindone JP. Effect of high-dose cranberry juice on the pharmacodynamics of warfarin in patients. Br J Clin Pharmacol. 2010; 70(1): 139-142. doi: 10.1111/j.1365-2125.2010.03674.x.

5. Al-Arifi MN, Wajid S, Al-Manie NK, et al..Evaluation of knowledge of Health care professionals on warfarin interactions with drug and herb medicinal in Central Saudi Arabia. Pak J Med Sci. 2016 JanFeb; 32(1): 229-233. doi: 10.12669/pjms.321.8902.

6. Militaru FC, Vesa SC, Pop TR, Buzoianu AD. Pharmacogenetics aspects of oral anticoagulants therapy. Med Life. 2015;8(2):171-5.

7. Fung E, Patsopoulos NA, Belknap SM, et al. Effect of genetic variants, especially CYP2C9 and VKORC1, on the pharmacology of warfarin. Thromb Hemost. 2012; 38(8): 893-904. doi: 10.1055/s-00321328891.

8. Sirotkina O.V., Ulitina A.S., Taraskina A.E., et al. CYP2C9*2 and CYP2C9*3 allele variants of CYP2C9 cytochrome gene in St. Petersburg population, and their clinical role in warfarin anticoagulant therapy. Russian Journal of Cardiology. 2004;(6):47-50. (In Russ.) [Сироткина О.В., Улитина А.С., Тараскина А.Е. и соавт. Аллельные варианты CYP2C9*2 и CYP2C9*3 гена цитохрома CYP2C9 в популяции Санкт-петербурга и их клиническое значение при антикоагулянтной терапии варфарином. Российский Кардиологический Журнал. 2004;6:47-50]. doi: 10.15829/1560-4071-2004-647-50.

9. Nikolaev N.A. Guide to Clinical Studies of Internal Diseases: A Scientific Monograph. Moscow: Izdatel'skij dom Akademii Estestvoznanija; 2015. (In Russ.) [Николаев Н.А. Руководство по клиническим исследованиям внутренних болезней: научная монография. М.: Издательский дом Академии Естествознания; 2015].

For citation:

Skirdenko J.P., Nikolayev N.A. NEW APPROACHES TO INDIVIDUALIZED CHOICE OF ORAL ANTICOAGULANTS IN PATIENTS WITH ATRIAL FIBRILLATION. Rational Pharmacotherapy in Cardiology. 2018;14(1):58-64. (In Russ.)

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ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)