Warfarina y raza
Resumen
Se sabe que la raza afecta la capacidad de predicción farmacogenética de la warfarina. Se reconoce a VKORC1 como el principal modulador de las diferencias étnicas en la respuesta a la warfarina; sin embargo, permanecen sin explicación hallazgos como la menor sensibilidad a variantes en este gen en afroamericanos. Igualmente, se reconoce a CYP2C9 como el principal gen en su eliminación, . Por esta razón, con la pretensión de entender mejor la respuesta a la warfarina se realizó una revisión sistemática de la literatura con el fin de revelar variantes génicas que mejoren la comprensión de la diferente respuesta a este fármaco dependiente de la raza. Se encontró que hay variantes génicas cuya reciente revelación mejora la comprensión de la respuesta no solo relacionadas con dosificación, sino con efectos clínicos como la tendencia a hemorragias tanto en los genes descritos como VKORC1 y CYP2C9, pero también en otras partes del genoma evidenciando la complejidad de la respuesta a este medicamento. En consecuencia, se plantea la posibilidad de desarrollar nuevos algoritmos con mayor capacidad de predicción adicionándoles las nuevas variantes génicas, mediante un enfoque estratificado o uno expandido. Estos desarrollos pueden ayudarse de nuevas tecnologías como el aprendizaje de máquina o la posibilidad de determinar objetivamente la raza mediante estrategias genómicas.
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