WORLD’S FIRST GENETIC-BLEEDING RISK SCORE (GBRS) DEVELOPED FOR PATIENTS ON ORAL ANTICOAGULANT THERAPY BY GENETIC RESEARCHERS OF SIR GANGA RAM HOSPITAL

(No one in India or World has ever derived and validated such a predicting  score)

(Full text of the research study is attached- Two Attachments )

World over anticoagulants are used for treatment and prevention of Thrombosis (blood clots) since early 1940s . Thrombosis is the formation of a blood clot inside a blood vessel obstructing the flow of blood in veins or arteries .  Many organs of the body like legs , heart , kidneys , brain , lungs etc are effected by Thrombosis .  Anticoagulants are used to treat or prevent formation of  Thrombus .    Despite its common usage , oral anticoagulant (OAC) therapy is associated with significant bleeding complications . Commonly used oral anticoagulants are warfarin or acitrom.  Several hospital based studies in India and the world have ranked anticoagulant-induced bleeding as the common cause of  5 % to 6.9 % hospital admissions  that occur due to adverse drug reactions .

Both genetic and non genetic factors (drug-drug interactions , additional medical conditions , age , history of bleeding ) are known to contribute towards bleeding or hemorrhage in patients on anticoagulant therapy .

Although , there are a few bleeding risk prediction scores available in the world , but most are derived from white population and more importantly , none have evaluated the predictive significance of genetic risk factors so far .

According to Dr I.C.Verma , Director  , Centre of  Medical  Genetics , Sir Ganga Ram Hospital , “The present research focused on deriving and validating a  ‘Genetic Bleeding Risk’ (GBR) score based on genetic and non- genetic factors associated with bleeding (both minor and major) in patients on long term anticoagulation therapy . Apart from variants in CYP2C9 and VKORC1 genes , variants in APOE , ABCB1 (MDR1) , CYP4F2 , F5 and F2 were also analysed in the current study . “

The study was conducted on 310 patients from Departments of  Vascular Surgery , Cardiac Surgery  and Neurology from August 2009 to August 2012 at Sir Ganga Ram Hospital , New Delhi , after approval from Ethics Board Committee of SGRH and is in accordance with the ethical standards of Declaration of Helsinki  (World Medical Association ) .

According to Dr Risha Nahar , Scientist at  Centre of Medical Genetics , Sir Ganga Ram Hospital “The study  adds new knowledge with regards to important genetic and non-genetic predictors of bleeding risk . Integration of these bleeding predictors in the routine anticoagulation management could help the clinician to use the proper doses  in the high risk patients . This can effectively reduce the number of bleeding episodes , thus sparing the patients from adverse outcomes and reducing hospital admissions .”

“The present study is the first to devise and validate a genetic scoring scheme for predicting bleeding among first time users of oral anticoagulants .  It uses age , four genetic markers and associated disorders like malignancy & renal disease  to predict the risk of bleeding  “ Dr Nahar further added .

Research Link Below