Studija slučaja

THE POSSIBLE ROLE OF PHARMACOGENETICS WHEN RESUMING ANTICOAGULATION FOLLOWING INTRACRANIAL HEMORRHAGE

MAJDA VRKIĆ KIRHMAJER orcid.org/0000-0002-1340-1917 ; Klinika za bolesti srca i krvnih žila, Klinički bolnički centar Zagreb, Zagreb, Hrvatska; Medicinski fakultet, Sveučilište u Zagrebu, Zagreb, Hrvatska *
LIVIJA ŠIMIČEVIĆ ; Klinički zavod za laboratorijsku dijagnostiku, Klinički bolnički centar Zagreb, Zagreb, Hrvatska; Zavod za medicinsku kemiju, biokemiju i kliničku kemiju, Medicinski fakultet, Sveučilište u Zagrebu, Zagreb, Hrvatska
DESIREE COEN HERAK ; Klinički zavod za laboratorijsku dijagnostiku, Klinički bolnički centar Zagreb, Zagreb, Hrvatska; Farmaceutsko-biokemijski fakultet, Sveučilište u Zagrebu, Zagreb, Hrvatska
ANA ŠUTALO ; Klinika za bolesti srca i krvnih žila, Klinički bolnički centar Zagreb, Zagreb, Hrvatska
LANA GANOCI ; Klinički zavod za laboratorijsku dijagnostiku, Klinički bolnički centar Zagreb, Zagreb, Hrvatska
TAMARA BOŽINA ; Zavod za medicinsku kemiju, biokemiju i kliničku kemiju, Medicinski fakultet, Sveučilište u Zagrebu, Zagreb, Hrvatska

* Dopisni autor.

Sažetak

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.

Ključne riječi

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

Hrčak ID:

331226

URI

https://hrcak.srce.hr/331226

Datum izdavanja:

16.5.2025.

Podaci na drugim jezicima: hrvatski

Posjeta: 299 *