Clinical significance of individualized anticoagulant therapy with warfarin based on pharmacogenomics in patients after cardiac valve replacement

Feng Pinpin; Dong Ran; Song Yue; Shi Xiujin; Lin Yang

doi:10.3760/cma.j.issn.1673-4777.2016.04.010

Abstract：Objective To discuss the clinical significance of individualized anticoagulant therapy with warfarin based on pharmacogenomics in patients after cardiac valve replacement.Methods Totally 60 patients undergoing cardiac valve surgery from May to September 2015 were randomly divided into genome group and control group (30 cases in each group).The warfarin doses were prescribed according to pharmacogenetic-based algorithms in genome group,while standard doses of warfarin were given in control group on the first 3 days;then the doses were adjusted according to international normalized ratio (INR).The primary outcome measure was the time percentage of reaching therapeutic INR 1.8 to 2.5 (standard anticoagucation) during the first 2 months.The time percentages of standard anticoagulation,inadequate anticoagulation and excessive anticoagulation were compared between groups.Results A total of 56 patients completed follow-up,including 27 cases in genotype group and 29 cases in control group.The time percentages of standard anticoagulation was (78 ± 16) ％ in genome group and (59 ± 17) ％ in control group,with significant difference between groups (P ＜ 0.001).The median time of reaching therapeutic INR was 27 (14,28) days in genome group and 21 (7,25) days in control group,with significant difference between groups (P =0.003).There were no significant differences in time percentage of inadequate anticoagulation and excessive anticoagulation between groups (P ＞ 0.05).Conclusion Parmacogenetic-based dosing is better than standard dosing during the initiation of warfarin therapy in patients with heart value replacement.