Pharmacogenetics of new oral anticoagulants

Abstract

The review presents modern studies the effect of genetic polymorphisms on the efficienty and safety of therapy with new oral anticoagulants. Hepatic carboxylesterase encoded by the CES1 gene and P-glycoprotein encoded by the ABCB1 gene affect dabigatran pharmacokinetics. The role of glucuronidation enzymes (UGT2B15, UGT1A9, UGT2B7) involved in active dabigatran metabolism is poorly understood. An increase in the peak apixaban concentration was noted in patients with the rs4148738 polymorphism of the ABCB1 gene. Polymorphisms rs776746 and rs77674 of the CYP3A5 gene affect concentration of apixaban in Asian patients and thus increased the bleeding risk. The effect SULT1A1 sulfotransferase on the metabolism of apixaban has yet to be studied. The BCRP protein encoded by the ABCG2 gene is a poorly studied but promising direction for the pharmacokinetics of apixaban. ABCB1 and CYP3A4 of the cytochrome P450 system affect the rivaroxaban metabolism, however, the number of studies devoted to examining the effect of polymorphisms of these genes on the rivaroxaban pharmacokinetics limited. Thus, large studies are needed to clarify the clinical relevance of genotyping in target patients taking new oral anticoagulants.

Keywords

• dabigatran
• apixaban
• rivaroxaban
• pharmacogenetics
• efficiency
• safety