Viva Examination Preparation: Public Health Concepts
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Red urine suggests bleeding (hematuria), a sign of warfarin toxicity. Warfarin is primarily metabolized by the liver enzyme CYP2C9. Genetic polymorphisms are variations in genes that can affect how well an enzyme works. Some individuals, including a higher proportion of people of Asian descent, have genetic variants of CYP2C9 that make the enzyme less active. This leads to slower metabolism of warfarin, causing it to accumulate at a standard dose and increase the risk of bleeding.
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