From the Research
There is no specific recommendation for increased INR monitoring after starting inclisiran, and patients on warfarin therapy should continue their regular INR monitoring schedule as previously established. Inclisiran, a small interfering RNA (siRNA) that reduces LDL cholesterol by inhibiting PCSK9 production, does not have known interactions with warfarin or other vitamin K antagonists that would necessitate more frequent INR monitoring 1. The unique mechanism of action of inclisiran, which is not metabolized through the cytochrome P450 system, likely contributes to the lack of significant drug-drug interactions affecting anticoagulation 2. However, as with any medication change in patients on anticoagulation therapy, clinicians should remain vigilant for any unexpected changes in INR values during routine monitoring after inclisiran initiation 3. Some key points to consider when monitoring patients on inclisiran and warfarin include:
- The regular INR monitoring schedule should be maintained, typically every 1-4 weeks for stable patients, or more frequently when initiating therapy or making dose adjustments 4
- Clinicians should be aware of the potential for inclisiran to lower LDL cholesterol levels by approximately 50% when added to statins, which may impact cardiovascular risk but not directly affect INR monitoring 5
- The safety and efficacy of inclisiran have been established in clinical trials, with a favorable safety profile and no significant adverse effects on measures of inflammation or immune activation 1