The Short-term Anticoagulation Therapy after Autologous Arteriovenous Fistulas Surgery Guided Based on VKORC1 Gene Polymorphism

DOI: 10.12201/bmr.202601.00045

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  Abstract: Objective: To explore and verify the influence of Vitamin K Epoxide Reductase Complex Subunit 1 (VKORC1) gene polymorphism on the short-term anticoagulation therapy effect and bleeding risk in patients after autogenous arteriovenous fistulas (AVF) surgery, aiming to provide individualized and precise guidance plans for short-term anticoagulation therapy after AVF surgery. Methods from March 2022 to November 2024, 154 patients who were scheduled to undergo AVF surgery in Jinhua Central hospital were studied and divided into the observation group (76 cases) and the control group (78 cases) by the random number table method. All patients received short-term anticoagulation therapy after the surgery. Peripheral blood samples of patients were collected before the surgery, and the polymorphism of the VKORC1 gene locus was detected by Quantitative Real-time PCR (qRT-PCR). Patients in the observation group were guided to take warfarin medication based on the VKORC1 genotype, while patients in the control group were treated with a conventional empirical anticoagulation therapy regimen. The changes of the international normalized ratio (INR) and the incidence of bleeding complications of the two groups during anticoagulation therapy were closely monitored and the dosage of warfarin was compared. Results Among the 76 patients in the observation group, 63 cases were of VKORC1-AA type (82.89%), 12 cases were of VKORC1-AG type (15.79%), and 1 case was of VKORC1-GG type (1.32%). In the control group, there were 57 cases of VKORC1-AA type (73.08%), 18 cases of VKORC1-AG type (23.08%), and 3 case of VKORC1-GG type (3.85%). There was no difference in the genotype diversity of VKORC1 between the two groups (χ2=2.743, P=0.290). The time for reaching the INR standard in the observation group was shorter than that in the control group (4.18±0.82) d vs (5.00±0.38) d. The initial dose of warfarin (1.97±0.62) ng/d vs (3.23±1.01) ng/d and the maintenance dose of warfarin (2.41±0.38) ng/d vs (2.92±0.97) ng/d were both lower than those in the control group. The incidences of minor bleeding events (15.79% vs 39.74%) and INR≥4.0 events (10.53% vs 29.49%) in the observation group were lower than those in the control group. There were no differences in the continuous patency rate (93.42% vs 92.31%) and the incidence of major bleeding events (1.32% vs 8.97%) 1 year after surgery between the two groups of patients (all P > 0.05). Conclusions The polymorphism of the VKORC1 gene has significant guiding significance in short-term anticoagulation therapy after AVF. Individualized anticoagulation therapy based on VKORC1 gene polymorphism can significantly enhance the effectiveness and safety of anticoagulation therapy and reduce the risk of bleeding.

  Key words: VKORC1 gene polymorphism; Autologous arteriovenous fistulas; Anticoagulant therapy; International normalized ratio; Safety

  Submit time: 15 January 2026

  Copyright: The copyright holder for this preprint is the author/funder, who has granted biomedRxiv a license to display the preprint in perpetuity.
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