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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...

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Detalles Bibliográficos
Autores principales: Fender, Anke C., Dobrev, Dobromir
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2019
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
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Dobrev, Dobromir
author_sort Fender, Anke C.
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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.
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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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