Genotyping of CYP2C9 and VKORC1 polymorphisms predicts south Indian patients with deep vein thrombosis as fast metabolizers of warfarin/acenocoumarin

Drug Discov Ther. 2017;11(4):198-205. doi: 10.5582/ddt.2017.01031.


Deep vein thrombosis (DVT) is a life-threatening disease. Warfarin and acenocoumarol are anticoagulants used to treat DVT and vary among individuals in terms of treatment response/toxicity. Single nucleotide polymorphisms (SNPs) in CYP2C9 and VKORC1 play a role in the pharmacokinetics and dynamics of warfarin and acenocoumarol and they determine the efficacy of treatment by controlling drug clearance in treated individuals. The aim of the current study was to genotype the critical SNPs of CYP2C9 and VKORC1 genes in a south Indian population in order to understand the metabolizer phenotype of patients with DVT. CYP2C9 (rs1799853, rs1057910, rs1057909, rs28371686) and VKORC1 (rs9923231) SNPs were genotyped in 124 cases of DVT. Genomic regions of these SNPs from genomic DNA were amplified with PCR and directly sequenced using Sanger sequencing except for the SNP rs1799853, which was detected using Sau96I restriction endonuclease-based digestion of variant alleles. Among south Indian patients with DVT, 6.5% (8/124) had the rs1799853 SNP of CYP2C9 and 11% (14/124) had the rs1057910 SNP while 16% (20/124) had the rs9923231 SNP of VKORC1 which were associated with the response to warfarin treatment. None of the patients tested positive for poor drug metabolizing genotypes of the CYP2C9 gene and only 1.6% of the south Indian population was sensitive to warfarin treatment. Genotyping results suggest that a relatively greater amount of the therapeutic drug is required to achieve/maintain the international normalized ratio (INR) in south Indian patients with DVT.

Keywords: CYP2C9; SNP; VKORC1; Warfarin; anti-coagulants; deep vein thrombosis; pharmacogenetics.

MeSH terms

  • Acenocoumarol / pharmacokinetics*
  • Acenocoumarol / therapeutic use
  • Adult
  • Anticoagulants / pharmacokinetics*
  • Anticoagulants / therapeutic use
  • Cytochrome P-450 CYP2C9 / genetics*
  • Humans
  • India
  • Pharmacogenomic Testing
  • Pharmacogenomic Variants
  • Polymorphism, Single Nucleotide
  • Venous Thrombosis / drug therapy*
  • Vitamin K Epoxide Reductases / genetics*
  • Warfarin / pharmacokinetics*
  • Warfarin / therapeutic use


  • Anticoagulants
  • Warfarin
  • CYP2C9 protein, human
  • Cytochrome P-450 CYP2C9
  • VKORC1 protein, human
  • Vitamin K Epoxide Reductases
  • Acenocoumarol