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Bound to bleed: How altered albumin binding may dictate warfarin treatment outcome
Although non-vitamin-K anticoagulants are now the preferred option for stroke prevention in atrial fibrillation (AF), warfarin is still used in a significant number of patients. Warfarin dosing requirements are susceptible to drug interactions and genetic polymorphisms in metabolising enzymes. Human...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6437285/ https://www.ncbi.nlm.nih.gov/pubmed/30963099 http://dx.doi.org/10.1016/j.ijcha.2019.02.007 |
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author | Fender, Anke C. Dobrev, Dobromir |
author_facet | Fender, Anke C. Dobrev, Dobromir |
author_sort | Fender, Anke C. |
collection | PubMed |
description | Although non-vitamin-K anticoagulants are now the preferred option for stroke prevention in atrial fibrillation (AF), warfarin is still used in a significant number of patients. Warfarin dosing requirements are susceptible to drug interactions and genetic polymorphisms in metabolising enzymes. Human serum albumin (HSA) is a candidate modifier of warfarin pharmacokinetics, with hypoalbuminemia now shown to correlate with supratherapeutic INR levels and annual bleeding risk. Warfarin is highly bound to HSA, and a relatively small shift, resulting from displacement by other xenobiotics, hypoalbuminemia or reduced binding capacity, can potentially lead to marked alterations in the free warfarin fraction. Precisely how this relates to the actual concentration of free, pharmacodynamically active, warfarin, is not clear, since measurement of this critical moiety remains an unsolved caveat. Yet awareness how disease, nutrition and polypharmacy affect warfarin binding to HAS and how this may impact (or not) on bioavailability and outcome, is essential for optimal treatment. |
format | Online Article Text |
id | pubmed-6437285 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-64372852019-04-08 Bound to bleed: How altered albumin binding may dictate warfarin treatment outcome Fender, Anke C. Dobrev, Dobromir Int J Cardiol Heart Vasc Editorial Although non-vitamin-K anticoagulants are now the preferred option for stroke prevention in atrial fibrillation (AF), warfarin is still used in a significant number of patients. Warfarin dosing requirements are susceptible to drug interactions and genetic polymorphisms in metabolising enzymes. Human serum albumin (HSA) is a candidate modifier of warfarin pharmacokinetics, with hypoalbuminemia now shown to correlate with supratherapeutic INR levels and annual bleeding risk. Warfarin is highly bound to HSA, and a relatively small shift, resulting from displacement by other xenobiotics, hypoalbuminemia or reduced binding capacity, can potentially lead to marked alterations in the free warfarin fraction. Precisely how this relates to the actual concentration of free, pharmacodynamically active, warfarin, is not clear, since measurement of this critical moiety remains an unsolved caveat. Yet awareness how disease, nutrition and polypharmacy affect warfarin binding to HAS and how this may impact (or not) on bioavailability and outcome, is essential for optimal treatment. Elsevier 2019-03-25 /pmc/articles/PMC6437285/ /pubmed/30963099 http://dx.doi.org/10.1016/j.ijcha.2019.02.007 Text en © 2019 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Editorial Fender, Anke C. Dobrev, Dobromir Bound to bleed: How altered albumin binding may dictate warfarin treatment outcome |
title | Bound to bleed: How altered albumin binding may dictate warfarin treatment outcome |
title_full | Bound to bleed: How altered albumin binding may dictate warfarin treatment outcome |
title_fullStr | Bound to bleed: How altered albumin binding may dictate warfarin treatment outcome |
title_full_unstemmed | Bound to bleed: How altered albumin binding may dictate warfarin treatment outcome |
title_short | Bound to bleed: How altered albumin binding may dictate warfarin treatment outcome |
title_sort | bound to bleed: how altered albumin binding may dictate warfarin treatment outcome |
topic | Editorial |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6437285/ https://www.ncbi.nlm.nih.gov/pubmed/30963099 http://dx.doi.org/10.1016/j.ijcha.2019.02.007 |
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