Yoshihisa Abe

Standard warfarin dose in a patient with the CYP2C9*3/*3 genotype leads to hematuria

BACKGROUNDnPatients with certain CYP2C9 genetic variants have increased sensitivity to warfarin and are at increased risk of over-coagulation with standard warfarin dose. We report over-anticoagulation and hematuria manifest as a slow increase in the international normalized ratio (INR) due to warfarin treatment in a patient with the CYP2C9*3/*3 allele.nnnCASEnA 58-y-old man with paroxysmal atrial fibrillation received a standard warfarin dose of 2.0mg/day. Because INR was 2.00 one week after treatment initiation, he was discharged from the hospital. One month later, hematuria was present and INR had increased to 7.26. Although in normal cases (R)-warfarin plasma concentrations are higher than (S)-warfarin, this patient had the opposite warfarin enantiomer plasma concentration profile.nnnCONCLUSIONSnIncreased anticoagulation was due to an increased concentration of (S)-warfarin, the more active warfarin enantiomer. INR response to warfarin in this CYP2C9*3/*3 patient was slow. The later INR response appears to be strongly affected by CYP2C9 variants. He also had the VKORC1 -1639G>A AA genotype, requiring a lower warfarin dose. In this case, increased risk of bleeding could have been identified by prospective genotyping of CYP2C9 and VKORC1 prior to initiating warfarin therapy.

Direct Dose Measurement On Patient During Percutaneous Coronary Intervention Procedures Using Radiophotoluminescence Glass Dosimeters.

The purpose of this research was to measure accurate patient entrance skin dose and maximum skin absorbed dose (MSD) to prevent radiation skin injuries in percutaneous coronary interventions (PCIs). We directly measured the MSD on 50 PCIs by using multiple radiophotoluminescence glass dosimeters and a modified dosimetry gown. Also, we analysed the correlation between the MSD and indirect measurement parameters, such as fluoroscopic time (FT), dose-area product (DAP) and cumulative air kerma (C-AK). There were very strong correlations between MSD and FT, DAP and C-AK, with the correlation between MSD and C-AK being the strongest (rxa0=xa00.938). In conclusion, the regression lines using MSD as an outcome value (y) and C-AK as predictor variables (x) were yxa0=xa01.12x (R2xa0=xa00.880). From the linear regression equation, MSD is estimated to be ~1.12 times that of C-AK in real time.