Pharmacogenetic dosing of warfarin in the Han-Chinese population: a randomized trial

Author:

Wen Ming-Shien12,Chang Kuan-Cheng34,Lee Tsong-Hai15,Chen Ying-Fu67,Hung Kuo-Chun12,Chang Yeu-Jhy15,Liou Chia-Wei18,Chen Jin-Jer34,Chang Chien-Hung15,Wang Chao-Yung12,Jeng Jiann-Shing8,Chuang Hui-Ping9,Chen Ying-Ting9,Chen Chien-Hsiun9,Wu Jer-Yuarn9,Chen Yuan-Tsong9,Lee Ming Ta Michael910

Affiliation:

1. College of Medicine, Chang Gung University, Taoyuan, Taiwan

2. Division of Cardiology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan

3. Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan

4. Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan

5. Stroke Center & Department of Neurology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan

6. Division of Cardiovascular Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan

7. Graduate Institute of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

8. Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan

9. Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan

10. Genomic Medicine Institute, Geisinger Health System, Danville, PA 17822, USA

Abstract

Aim: This study aimed to determine clinical utility of genotype-guided dosing for warfarin in Han-Chinese. Methods: A total of 320 patients were randomly assigned International Warfarin Pharmacogenetic Consortium algorithm, Taiwan algorithm and optimal clinical care arms. The primary outcome of the study was the percentage of time in the therapeutic range during the first 90 days of treatment. Results: The percentage of time in the therapeutic range of the clinical care group in the first 2 weeks was significantly higher than the algorithm groups. This difference was no longer observed after 4 weeks. No difference in excessive anticoagulation (international normalized ratio ≥4.0) and adverse events was observed. Conclusion: Genotype-guided dosing did not provide significant benefit. Loading dose with frequent international normalized ratio monitoring could provide sufficient control of anticoagulation.

Publisher

Future Medicine Ltd

Subject

Pharmacology,Genetics,Molecular Medicine

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