Case report, case study

THE POSSIBLE ROLE OF PHARMACOGENETICS WHEN RESUMING ANTICOAGULATION FOLLOWING INTRACRANIAL HEMORRHAGE

MAJDA VRKIĆ KIRHMAJER orcid.org/0000-0002-1340-1917 ; Department of Cardiovascular Diseases, University Hospital Center Zagreb, Zagreb, Croatia; University of Zagreb School of Medicine, Zagreb, Croatia *
LIVIJA ŠIMIČEVIĆ ; Department of Laboratory Diagnostics, University Hospital Center Zagreb, Zagreb, Croatia; Department of Medical Chemistry, Biochemistry and Clinical Chemistry, University of Zagreb School of Medicine, Zagreb, Croatia
DESIREE COEN HERAK ; Department of Laboratory Diagnostics, University Hospital Center Zagreb, Zagreb, Croatia; Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
ANA ŠUTALO ; Department of Cardiovascular Diseases, University Hospital Center Zagreb, Zagreb, Croatia
LANA GANOCI ; Department of Laboratory Diagnostics, University Hospital Center Zagreb, Zagreb, Croatia
TAMARA BOŽINA ; Department of Medical Chemistry, Biochemistry and Clinical Chemistry, University of Zagreb School of Medicine, Zagreb, Croatia

* Corresponding author.

Abstract

Intracranial hemorrhage (ICH) is the most feared complication of anticoagulation, therefore resuming anticoagulation following ICH is challenging. We present the case of a 76-year-old man with progression of left leg deep venous thrombosis (DVT). His previous anticoagulant DVT treatment was complicated by ICH and the anticoagulant was stopped. Without anticoagulant therapy, DVT symptoms worsened. Careful anticoagulant reintroduction was initiated. After two months of subcutaneous enoxaparin application, the patient desired a direct oral anticoagulant (DOAC). Several considerations are important prior to DOACs introduction: age, renal and hepatic function, drug-drug interactions, and bleeding risk. To avoid possible genetically determined DOAC pharmacokinetics alteration and drug-drug interactions, a pharmacogenetic analysis was performed. Following the pharmacogenetic findings, reduced dabigatran doses were introduced. Optimal plasma dabigatran concentrations were confirmed, and the further clinical course was uneventful. An individual approach with pharmacogenetic testing can provide additional information in selecting the appropriate medication in an optimal dosage.

Keywords

cytochrome P450; dabigatran; DOAC; P-glycoprotein; pharmacogenetic; thrombosis

Hrčak ID:

331226

URI

https://hrcak.srce.hr/331226

Publication date:

16.5.2025.

Article data in other languages: croatian

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