Ethnic differences in warfarin maintenance dose requirement and its relationship with genetics

Warfarin is a highly efficacious drug, but management of warfarin is difficult, in part because of the large interindividual maintenance dose differences. Warfarin dose requirements differ by race and it has been suggested that some of these differences are owing to genetic diversity. For example, persons of African descent have lower allele frequencies of the CYP2C9*2 and *3 and VKORC1 1173T allele, which have been associated with lower warfarin dose requirements in Caucasians. Since there is currently debate whether genetic information should be used in clinical practice to determine the starting dose for a warfarin initiator, it is of great importance to determine whether everyone will benefit from this knowledge.