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

Šupe, Svjetlana and Poljaković, Zdravka and Božina, Tamara and Ljevak, Josip and Macolić Šarinić, Viola and Božina, Nada (2015) Clinical application of genotype-guided dosing of warfarin in patients with acute stroke. Archives of Medical Research, 46 (4). pp. 265-273. ISSN 0188-4409

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Abstract

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.

Item Type: Article
Additional Information: Copyright © 2015 IMSS. Published by Elsevier Inc. All rights reserved.
MeSH: 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
Departments: Katedra za neurologiju
Depositing User: Marijan Šember
Status: Published
Creators:
CreatorsEmail
Šupe, SvjetlanaUNSPECIFIED
Poljaković, ZdravkaUNSPECIFIED
Božina, TamaraUNSPECIFIED
Ljevak, JosipUNSPECIFIED
Macolić Šarinić, ViolaUNSPECIFIED
Božina, NadaUNSPECIFIED
Date: May 2015
Date Deposited: 03 Aug 2016 08:05
Last Modified: 24 Jul 2020 09:19
Subjects: /
Related URLs:
URI: http://medlib.mef.hr/id/eprint/2612

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