Clinical application of genotype-guided dosing of warfarin in patients with acute stroke

Scientific paper - Original scientific paper

• Author: Svjetlana Šupe
• Author: Zdravka Poljaković
• Author: Tamara Božina
• Author: Josip Ljevak
• Author: Viola Macolić Šarinić
• Author: Nada Božina
• Author's institution: University of Zagreb; School of Medicine
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences

Abstract (english)

BACKGROUND:

Patients with certain types of stroke need urgent anticoagulation and it is extremely important for them to achieve fast and stable anticoagulant effect and receive individualized treatment during the initiation of warfarin therapy. ----- METHODS:

We conducted a prospective study among 210 acute stroke patients who had an indication for anticoagulation and compared the impact of CYP2C9 and VKORC1 genotype-guided warfarin dosing (PhG) with fixed dosing (NPhG) on anticoagulation control and clinical outcome between groups. ----- RESULTS:

PhG achieved target INR values earlier, i.e., on average in 4.2 (4.1-4.7, 95% CI) days compared to NPhG (5.2 days [4.7-6.4, 95% CI]) (p = 0.0009), spent a higher percentage of time in the therapeutic INR range (76.3% [74.7-78.5, 95% CI] vs. 67.1% [64.5-69.6, 95% CI] in NPhG), and spent less time overdosed (INR > 3.1) (PhG 0.4 [0.1-0.7, 95% CI], NPhG 1.7 [1.1-2.3, 95% CI] days; p >0.000). PhG reached stable maintenance dose faster (10 [9.9-10.7, 95% CI] vs. 13.9 [13.3-14.7, 95% CI] days in controls; p = 0.0049) and had a better clinical outcome in relation to neurological deficit on admission as compared to NPhG. ----- CONCLUSION:

We confirmed that warfarin therapy with genotype-guided dosing instead of fixed dosing reduces the time required for stabilization and improves anticoagulant control with better clinical outcome in early stages of warfarin therapy introduction among acute stroke patients, which is essential for clinical practice.

• Keywords (english): Aged; Aged, 80 and over; Anticoagulants/administration & dosage; Cytochrome P-450 CYP2C9/genetics; Female; Genotype; Humans; Male; Middle Aged; Precision Medicine; Prospective Studies; Stroke/drug therapy; Stroke/genetics; Vitamin K Epoxide Reductases/genetics; Warfarin/administration & dosage
• Language: english
• Publication type: Scientific paper - Original scientific paper
• Publication status: Published
• Peer review: Peer review
• Publication version: Accepted version
• Journal title: Archives of Medical Research
• Numbering: vol. 46, no. 4, pp. 265-273
• p-ISSN: 0188-4409
• DOI: https://doi.org/10.1016/j.arcmed.2015.05.001
• URN:NBN: urn:nbn:hr:105:104568
• Publication: 2015-05
• Document URL: https://doi.org/10.1016/j.arcmed.2015.05.001
• Type of resource: Text
• Access conditions: Open access
• Created on: 2024-03-28 08:39:13