Oral anticoagulants, or blood thinners, are widely used to prevent and treat strokes, heart attacks and venous clots. Researchers at the University of Alabama at Birmingham will tackle the most feared complication of anticoagulation therapy — serious or fatal hemorrhage or bleeding — with a $3.5 million grant from the National Heart, Lung and Blood Institute, one of the National Institutes of Health.
Anticoagulants, including warfarin (Coumadin), dabigatran (Pradaxa), rivaroxaban (Xarelto) and apixaban (Eliquis), are effective in preventing and treating clots. However, hemorrhage or uncontrolled bleeding related to the use of anticoagulants is a frequent complication and common reason for hospitalizations across the United States.
UAB researchers have spearheaded efforts to understand how an individual’s genetic makeup, clinical factors, environment and lifestyle interact to affect response to warfarin, the most commonly used oral anticoagulant. While continuing research on warfarin, the research team will also create a prospective cohort of atrial fibrillation patients treated with dabigatran. The study will implement a comprehensive genomic approach to assess both common and rare genetic variations with an aim of identifying novel genetic variants associated with hemorrhage.
|UAB researchers have spearheaded efforts to understand how an individual’s genetic makeup, clinical factors, environment and lifestyle interact to affect response to warfarin, the most commonly used oral anticoagulant.|
“One of the unique and most important aspects of our UAB research efforts over the years was to build this cohort of patients on anticoagulants whom we can follow for up to two years after initiation of therapy,” said Nita Limdi, Pharm.D., Ph.D., associate professor in the Department of Neurology and primary investigator of the new study. “This allows us to observe bleeding complications to better understand and study the influence of genes, clinical factors and environment. The capability of observing bleeding complications in real time is a valuable tool in understanding this process and was a key element in securing this grant.”
UAB is uniquely qualified to conduct studies of this nature, having developed one of the largest prospective warfarin study cohorts in the country, with over 1,400 subjects. It also has the most racially diverse cohorts as nearly half of the participants are African-Americans, who make up a sizable at-risk population for complications from anticoagulants.
Limdi points out that this research is another step toward personalized medicine. The study will begin to develop algorithms, including clinical, genetic and environmental factors, to predict a patient’s risk of hemorrhage. Such tools will enable clinicians to refine patient-specific risk-benefit assessments and help determine personalized choices for oral anticoagulant therapy.