anticoagulants, vitamin K antagonists, warfarin
DISEASE INTERVENTION COMPARISON RESULTS
N Engl J Med. 2008 Mar 6;358(10):999-1008 Descriptive
IN anticoagulants, vitamin K antagonists, warfarin The Use of
genetic variants of vitamin K epoxide reductase (VKORC1), the target of warfarin
As Diagnostic Tool
Is better Than
genetic variants of cytochrome P-450 2C9 (CYP2C9), which metabolises warfarin
To predict the time to the first INR within the therapeutic range or in excess
Circulation. 2007 Nov 27;116(22):2563-70 Randomized Controlled Trial
IN anticoagulants, vitamin K antagonists, warfarin The Use of
pharmacogenetic guided dosing, using CYP2C9 and VKORC1 genotype
As Dosage Scheme
Is equal Than
standard empirical dosing
To reduce time of out-of-range INR (31% genotyping VS 33% standard) or proportion of patients reaching therapeutic INR at day 5 or 8.
J Am Coll Cardiol. 2011 Feb 1;57(5):612-8 Cohorts
IN anticoagulants, vitamin K antagonists, warfarin The Use of
pharmacogenetic guided dosing, using CYP2C9 and VKORC1 genotype, combined with clinical information in a formal algorithm
As Dosage Scheme
Is better Than
methods using only clinical information (empiric or a formal clinical algorithm), or methods using only genetic data
To improve the proportion of patients whose predicted doses were within 20% of their actual therapeutic doses: 52% pharmacogenetic algorithm, 43% genetic data, 39% clinical algorithm, 37% empiric dosing.
N Engl J Med. 2005 Jun 2;352(22):2285-93 Clinical Trial (non-controlled, non-randomized)
IN anticoagulants, vitamin K antagonists, warfarin The Use of
vitamin K epoxide reductase complex 1 (VKORC1) haplotipes
As Dosage Scheme
Is useful Than
no comparison here
To stratify patients into low-, intermediate-, and high-dose warfarin groups
N Engl J Med. 2013 Dec 12;369(24):2283-93 Randomized Controlled Trial, Multicenter Study
IN anticoagulants, vitamin K antagonists, warfarin The Use of
pharmacogenetic guided dosing, a dosing algorithm that included both clinical variables and genotype data
As Treatment, Acute
Is equal Than
a dosing algorithm that included only clinical variables
To modify the percentage of time that the INR was in the therapeutic range from day 4 through day 28 of therapy
N Engl J Med. 2013 Dec 12;369(24):2294-303 Study type to be defined
IN anticoagulants, vitamin K antagonists, warfarin The Use of
pharmacogenetic guided dosing, using CYP2C9 and VKORC1 genotype, combined with clinical information in an algorithm
As Treatment, Acute
Is better Than
standard empirical dosing of warfarin
To improve the percentage of time that the INR was in the therapeutic range in the first 12 weeks after initiation of therapy: 67% with pharmacogenetics VS 60% clinical
Ann Intern Med. 2003 May 6;138(9):714-9 Randomized Controlled Trial
IN anticoagulants, vitamin K antagonists, warfarin, thromboembolic disease The Use of
higher starting dose: 10 mg/day
As Treatment, Acute
Is better Than
usual starting dose: 5 mg/day
To reduce time to achieve therapeutic INR at day 5 (83% with 10mg VS 46% with 5mg, overall reduction by 1.5 days). No significant differences in major bleeding, coagulation excess (INR > 5.0), recurrent events and survival.