Pharmacogenetic approach to prescribing medications in cardiac surgery patients at high risk of complications
L. V. Selivanova,
M. V. Lukina,
V. S. Yudin,
D. A. Petrenko,
K. A. Vilizhinskaya,
Yu. S. Gilevskaya,
S. O. Popov,
I. V. Sychev,
D. E. Rozhkov,
K. B. Mirzaev,
D. A. Sychev https://doi.org/10.37489/2588-0527-0012
EDN: FSWEGZ
Abstract
Introduction. Cardiac surgery patients are at high pharmacological risk due to comorbidities, polypharmacy, and cardiopulmonary bypass.
Search methods. A literature search was conducted in PubMed/MEDLINE, Web of Science, Scopus, and eLibrary.ru (2015-2025) using keywords: “pharmacogenetics AND cardiac surgery”, “warfarin pharmacogenetics”, “clopidogrel CYP2C19”, “SLCO1B1 statin myopathy”, “drug-gene interactions”. In total, 42 sources were selected and analyzed. Inclusion criteria: original studies, meta-analyses, systematic reviews, and clinical guidelines in English or Russian. Exclusion criteria: single case reports, experimental studies, conference abstracts without full text.
Results. VKORC1 and CYP2C9 polymorphisms account for 50–60 % of warfarin dose variability; genotyping reduces bleeding risk and accelerates time to therapeutic INR. Loss-of-function CYP2C19 alleles impair clopidogrel activation, increasing ischemic event risk. The SLCO1B1 variant is associated with higher risk of statin-induced myopathy. In the Russian population, the frequency of clinically relevant alleles is comparable to European populations. Drug — gene and drugdrug-gene interaction concepts may potentiate adverse outcomes. Implementation of pharmacogenetic testing is limited by organizational, financial, and educational barriers.
Conclusion. For cardiac surgery patients, a multiparametric algorithm incorporating multilocus genotyping (CYP2C9, VKORC1, CYP2C19, SLCO1B1, ABCG2), clinical factor assessment, and drug interaction evaluation is the most promising strategy.
About the Authors
L. V. Selivanova
Petrovsky National Research Centre of Surgery
Russian Federation
Russian Federation
Lyubov V. Selivanova — Head of the Centralized Department of Clinical Pharmacology, Clinical Pharmacologist, Scientific Clinical Center No. 1
Moscow
M. V. Lukina
Petrovsky National Research Centre of Surgery;
Pirogov City Clinical Hospital No.1
Russian Federation
Russian Federation
Maria V. Lukina — Cand. Sci. (Med.), Clinical Pharmacologist, Pirogov City Clinical Hospital No. 1; Senior Researcher, Scientific Clinical Center No. 1, B. V. Petrovsky Russian Scientific Center of Surgery
Moscow
V. S. Yudin
Russian Medical Academy of Continuous Professional Education
Russian Federation
Russian Federation
Vladislav S. Yudin — Resident, Department of Clinical Pharmacology and Therapy named after B. E. Votchal
Moscow
D. A. Petrenko
Petrovsky National Research Centre of Surgery
Russian Federation
Russian Federation
Daria A. Petrenko — Clinical Pharmacologist, Scientific Clinical Center No. 1, Junior Researcher
Moscow
K. A. Vilizhinskaya
Petrovsky National Research Centre of Surgery
Russian Federation
Russian Federation
Kristina A. Vilizhinskaya — Cardiologist, Junior Researcher, Scientific Clinical Center No. 1
Moscow
Yu. S. Gilevskaya
Petrovsky National Research Centre of Surgery
Russian Federation
Russian Federation
Yulia S. Gilevskaya — Resident in Cardiovascular Surgery, Scientific Clinical Center No. 1
Moscow
S. O. Popov
Petrovsky National Research Centre of Surgery
Russian Federation
Russian Federation
Sergey O. Popov — Cand. Sci. (Med.), Chief Physician, Scientific Clinical Center No. 1
Moscow
I. V. Sychev
Petrovsky National Research Centre of Surgery
Russian Federation
Russian Federation
Ivan V. Sychev — researcher of the World-Class Genomic Research Center "Center for Predictive Genetics, Pharmacogenetics, and Personalized Therapy"
Moscow
D. E. Rozhkov
Petrovsky National Research Centre of Surgery
Russian Federation
Russian Federation
Denis E. Rozhkov — Cand. Sci. (Med.), Cardiologist, Deputy Chief Physician for Medical Affairs, Scientific Clinical Center No. 1
Moscow
K. B. Mirzaev
Petrovsky National Research Centre of Surgery;
Russian Medical Academy of Continuous Professional Education
Russian Federation
Russian Federation
Karin B. Mirzaev — Dr. Sci. (Med.), Associate Professor, Deputy Head of the World-Class Genomic Research Center "Center for Predictive Genetics, Pharmacogenetics, and Personalized Therapy" of the B. V. Petrovsky Russian Scientific Center of Surgery; Professor of the Department of Clinical Pharmacology and Therapy named after B. E. Votchal, Russian Medical Academy of Continuous Professional Education
Moscow
D. A. Sychev
Petrovsky National Research Centre of Surgery;
Russian Medical Academy of Continuous Professional Education
Russian Federation
Russian Federation
Dmitry A. Sychev — Dr. Sci. (Med.), Professor, Professor of the Russian Academy of Sciences, Academician of the Russian Academy of Sciences, scientific supervisor of the World-Class Genomic Research Center "Center for Predictive Genetics, Pharmacogenetics, and Personalized Therapy" of the B. V. Petrovsky Russian Scientific Center of Surgery; Head of the Department of Clinical Pharmacology and Therapy named after B. E. Votchal, Russian Medical Academy of Continuous Professional Education
Moscow
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For citations:
Selivanova L.V., Lukina M.V., Yudin V.S., Petrenko D.A., Vilizhinskaya K.A., Gilevskaya Yu.S., Popov S.O., Sychev I.V., Rozhkov D.E., Mirzaev K.B., Sychev D.A. Pharmacogenetic approach to prescribing medications in cardiac surgery patients at high risk of complications. Pharmacogenetics and Pharmacogenomics. 2026;(2):70-81. (In Russ.) https://doi.org/10.37489/2588-0527-0012. EDN: FSWEGZ
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