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Genetic polymorphism in CYP2C9 inhibits metabolism of warfarin and increases inhibition of VKOR (vitamin K epoxide reductase) which reduces vitamin K which is required for the carboxylation (activation) of coagulation factors VII, IX, and X – bleeding. Genetic polymorphism in VKOR (target for warfarin) prevents reduction of vitamin K – Bleeding. Polymorphisms of both, much higher incidence of bleeding.
