A rare combination of CYP2C9*3/*3 and VKORC1 1639AA in a patient had myxoma and thromboembolism

We report a case of intolerance to warfarin. A 20-year-old woman with toe pain was diagnosed as myxoma with multiple systemic embolism. She was prescribed warfarin for remaining embolic pain after myxoma excision and mitral annuloplasty. Even on 1 mg of warfarin, INR was much increased. The patient have the Cytochrome P450 2C9 (CYP2C9)*3/*3 and vitamin K epoxide reductase complex subunit 1 (VKORC1) 1639AA genotype, extremely rare in Koreans. Based on this result, we assessed the potential risks and benefits of warfarin, and decided to switch to aspirin because the risk of bleeding was considered to be too high.
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research