Personalized approach of medication by indirect anticoagulants tailored to the patient—Russian context: what are the prospects?

Pharmacogenomics is an important part of personalized medicine which implies that a physician chooses drugs and their doses taking into account individual genetic characteristics of a patient (Figure 1). The danger of receiving indirect anticoagulants is associated with an overdose of the drug that leads to bleeding of varying severity. Moreover, sometimes there is no effect of the treatment in spite of the increase in the dose. Existing methods of the choice of warfarin doses should be improved including molecular genetic analysis of key drug metabolism genes in the diagnostic algorithm.Warfarin is an oral anticoagulant widely used around the world. For the first time, this drug was synthesized in the laboratory of Karl Link in Wisconsin in 1948, and since the 1950s, it was introduced into clinical practice. Warfarin is commonly used for prevention of thromboembolism in patients with chronic thrombus (blood clot) formed, for example, in atrial fibrillation, prosthetic heart valves and deep venous thrombosis, and for stroke prevention in patients with atrial fibrillation [2,3]. Anticoagulants play a special role in the prevention of thromboembolic complications of cardiovascular diseases. CVD is one of the major targets for predictive, preventive and personalized medicine. A lot of investigations are aimed at identifying risk factors for cardiovascular diseases and prevention strategies [4-7]. For example, in Japan, the combination of public health and personalized treatment activities had contributed to substantial decline in mortality from stroke and ischemic heart disease between the 1960s and 2000s [7].Thrombosis is a life-threatening condition and one of the main causes of mortality and disability, bringing huge economic loss in Russia. Major complications of anticoagulant therapy are bleeding, which are observed in about 8% of patients receiving warfarin for a year. One percent of them are classified as severe cases (intracranial, retroperitoneal) resulting in