More recently, it has become clear that genetic factors that lead to differences in warfarin sensitivity are also important. There are many factors that have been reported to influence warfarin dose, including concomitant medication, diet, increasing age, liver volume, vitamin K status, and occult malignancy. Warfarin treatment is problematic because of the wide interindividual and intra-individual variation in dosage requirements. “Interindividual variation in warfarin dosage requirements is the result of a complex interaction between environmental and genetic factors” Multiple indications for longterm anticoagulation have become accepted, including patients with recurrent venous thrombosis, prosthetic heart valves, stroke prevention in atrial fibrillation, and anti-phospholipid syndrome. The anticoagulant effect of warfarin results from the inhibition of the γ carboxylation step in the synthesis of the vitamin K dependent clotting factors II, VII, IX, and X. There has been a dramatic increase in the number of patients receiving longterm anticoagulation with warfarin in recent years.
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