Genotype-guided warfarin dosing versus conventional dosing strategies: a systematic review and meta-analysis of randomized controlled trials
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AbstractAims:
Previous trials on the effectiveness of genotype‐guided warfarin dosing versus conventional dosing have been inconclusive. We conducted a systematic review and meta‐analysis of randomized trials comparing genotype‐guided to conventional dosing strategies.
Methods:
PubMed and Cochrane Library were searched until 23rd October 2017.
Results:
A total of 76 and 94 entries were retrieved. A total of 2626 subjects in the genotype‐guided dosing (mean age: 63.3 ± 5.8 years; 46% male) and 2604 subjects in the conventional dosing (mean age: 64.7 ± 6.1 years; 46% male) groups (mean follow‐up duration: 64 days) from 18 trials were included. Compared to conventional dosing, genotype‐guided dosing significantly shortened the time‐to‐first therapeutic INR (mean difference: 2.6 days, standard error: 0.3 days, P<0.0001; I2: 0%) and time‐to‐first stable INR (mean difference: 5.9 days, standard error: 2.0 days, P<0.01; I2: 94%). Genotype‐guided dosing also increased the Time in Therapeutic Range (TTR) (mean difference: 3.1%, standard error: 1.2%, P<0.01; I2: 80%), and reduced the risks of both excessive anticoagulation defined as INR ≥ 4 (risk ratio [RR]: 0.87; 95% CI: 0.78‐0.98; P<0.05; I2: 0%) and bleeding (RR: 0.82; 95% CI: 0.69‐0.98; P<0.05; I2: 31%). No difference in thromboembolism (RR: 0.84; 95% CI: 0.56‐1.26; P=0.40; I2: 0%) or mortality (RR: 1.16; 95% CI: 0.46‐2.91; P=0.76; I2: 0%) was observed between the two groups.
Conclusions:
Genotype‐guided warfarin dosing offers better safety with less bleeding compared to conventional dosing strategies. No significant benefit on thromboembolism or mortality was evident.
Acceptance Date17/04/2018
All Author(s) ListTse G, Gong M, Li G, Wong SH, Wu WKK, Wong WT, Roever L, Lee APW, Lip GYH, Wong MCS, Liu T, International Health Informatics Study (IHIS) Network
Journal nameBritish Journal of Clinical Pharmacology
Year2018
Month9
Volume Number84
Issue Number9
Pages1868 - 1882
ISSN0306-5251
eISSN1365-2125
LanguagesEnglish-United Kingdom
KeywordsCYP2C9, CYP4F2, dosing, genotype, VKORC1, warfarin

Last updated on 2020-06-08 at 04:26