Clinical Observations in Geriatrics
Published: 2016-06-15

Clinical, drugs interactions and pharmacogenetics evaluation of Warfarin treatment in an elderly patient: a case report

Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy
Department of Medicine and Surgery, University of Salerno, Baronissi (SA), Italy
Department of Medicine and Surgery, University of Salerno, Baronissi (SA), Italy
Department of Anesthesiology, Surgical and Emergency Sciences, Second University of Naples, Italy
“S. Maugeri” Foundation, Scientific Institute of Telese Terme, IRCCS, Telese Terme, Italy
Department of Medicine and Surgery, University of Salerno, Baronissi (SA), Italy
Elderly Pharmacogenetics Long-term setting Warfarin

Abstract

Introduction. Cardiovascular diseases are very prevalent in the elderly population and characterized by high
complexity, poor prognosis and comorbidity. Atrial fibrillation is common in elderly patients both in institutionalized
in long-term care facilities and in community associated or not to congestive heart failure, but the management
with anticoagulant oral therapy is highly variable and problematic.
Case presentation. Here we describe a case report on a patient treated with amiodarone and heparine for
acute atrial fibrillation episodes. Three years before he underwent partial intestinal resection for bowel cancer.
During Warfarin therapy a treatment with neomycin sulphate/bacitracin was started. After three days of Warfarin
therapy an International Normalised Ratio (INR) value > 10 was found. No bleeding occurred, but the period
of hospitalization was prolonged. After genotype assessment for CYP2C9 and VKORC1 he was found to be an
intermediate metabolizer with the genotype of CYP2C9*1/*2, and homozygous for VKORC1*2/*2. By using the
International Warfarin Pharmacogenetics Consortium algorithm, the estimated therapeutic Warfarin dose was
1.8 mg/day, less than a half of prescribed dose.
Conclusion. A preventive pharmacogenetic assessment could be very useful in defining the right dose of
Warfarin to be administered especially in elderly patients institutionalized in long-term care facilities with comorbidity
and polypharmacy.

Affiliations

G. Corbi

Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy

V. Simeon

Department of Medicine and Surgery, University of Salerno, Baronissi (SA), Italy

V. Conti

Department of Medicine and Surgery, University of Salerno, Baronissi (SA), Italy

N. Ferrara

Department of Anesthesiology, Surgical and Emergency Sciences, Second University of Naples, Italy

F. Cacciatore

“S. Maugeri” Foundation, Scientific Institute of Telese Terme, IRCCS, Telese Terme, Italy

A. Filippelli

Department of Medicine and Surgery, University of Salerno, Baronissi (SA), Italy

Copyright

© Società Italiana di Gerontologia e Geriatria (SIGG) , 2016

How to Cite

[1]
Corbi, G., Simeon, V., Conti, V., Ferrara, N., Cacciatore, F. and Filippelli, A. 2016. Clinical, drugs interactions and pharmacogenetics evaluation of Warfarin treatment in an elderly patient: a case report. JOURNAL OF GERONTOLOGY AND GERIATRICS. 64, 2 (Jun. 2016), 70-72.
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