ABSTRACT
A 73-yr-old Korean man with permanent atrial fibrillation visited outpatient clinic with severely increased International Normalized Ratio (INR) values after taking a usual starting dosage of warfarin to prevent thromboembolism. We found out later from his blood tests that he had hyperthyroidism at the time of treatment initiation. His genetic analysis showed CYP2C9*1/*3 and VKORC1+1173TT genotypes. We suspect that both hyperthyroidism and genetic variant would have contributed to his extremely increased INR at the beginning of warfarin therapy. From this case, we learned that pharmacogenetic and thyroid function test might be useful when deciding the starting dosage of warfarin in patients with atrial fibrillation.
Subject(s)
Aged , Humans , Male , Anticoagulants/blood , Aspirin/therapeutic use , Atrial Fibrillation/diagnosis , Chromatography, High Pressure Liquid , Cytochrome P-450 CYP2C9/genetics , Genotype , Polymorphism, Single Nucleotide , Tandem Mass Spectrometry , Thromboembolism/prevention & control , Thyrotoxicosis/diagnosis , Vitamin K Epoxide Reductases/genetics , Warfarin/bloodABSTRACT
The effect of the warfarin LD50 on the counts of the blood cells of Norway rat, Rattus norvegicus and roof rat, Rattus rattus from Giza and Qualyobia Governorates was investigated in the laboratory. Warfarin toxication caused significantly different blood cell counts in treated rats compared to control ones. Warfarin significantly decreased the total erythrocytic count and increased the total leucocytic count of treated rats. But, it caused significant de-crease in neutrophrils, eosinophils, basophils and monocytes, but significant increase in lymphocytes. The data also showed that in survived rats, WBC count equaled the normal level or slightly exceeded it at 33/43 days post treatment
Subject(s)
Animals, Laboratory , Warfarin/blood , Blood Cell Count/methods , Rats/blood , Anticoagulants/adverse effectsABSTRACT
The separation and determination of Warfarin as anticoagulant Coumarin in serum was done, after the extraction by high performance liquid chromatography reverse phase [HPLC-RP], where we have extracted serum with two special methods, they were solid-liquid extraction [SPE: sep-pack plus Cartridge] and liquid-liquid extraction. Methods of extraction were accurate and sensitive depending on qualitative and quantitative studies, that Regression coefficient was 0.9997, Variation coefficient was between 0.3-2% and limit of detection was 1.5 micro g/ ml. The best mobile phase was achieved by 95% methanol, 5% water [pH = 4] using ODS S micro m [4.6 mm x 250 mm] Nucleosil. The determination method was applied to qualify serum Warfarin concentration from patient's serum using it as anticoagulant oral tablets. That method has given good sensitive accurate results which are used in routine clinical control in medical laboratories