Development and Comparison of a Warfarin-Dosing Algorithm for Korean Patients With Atrial Fibrillation

Cho, Hyun Jung; On, Young-Keun; Bang, Oh Young; Kim, Jong-Won; Huh, Wooseong; Ko, Ji Hyun; Kim, June Soo; Lee, Soo-Youn

doi:10.1016/j.clinthera.2011.09.004

Cited by 32 publications

(34 citation statements)

References 42 publications

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“…The IWPC model includes the variables VKORC1 (rs9923231), CYP2C9 (*2 and *3), age, height, weight, race and the following interacting drugs: enzyme inducers and amiodarone (Table 2) [1]. Several studies have externally validated the IWPC model together with other models, and the overall conclusion is that the IWPC model performs well; however, the sample size has been small in these studies [46][47][48]. In 2010 the US FDA updated their Coumadin label with a table giving stable dosing recommendations per genotype of CYP2C9 and VKORC1 (Table 1).…”

Section: When To Predict Warfarin Dosementioning

confidence: 99%

Prediction of Warfarin Dose: Why, When and How?

Eriksson

Wadelius

2012

Pharmacogenomics

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Prediction models are the key to individualized drug therapy. Warfarin is a typical example of where pharmacogenetics could help the individual patient by modeling the dose, based on clinical factors and genetic variation in CYP2C9 and VKORC1. Clinical studies aiming to show whether pharmacogenetic warfarin dose predictions are superior to conventional initiation of warfarin are now underway. This review provides a broad view over the field of warfarin pharmacogenetics from basic knowledge about the drug, how it is monitored, factors affecting dose requirement, prediction models in general and different types of prediction models for warfarin dosing.

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Section: When To Predict Warfarin Dosementioning

confidence: 99%

Prediction of Warfarin Dose: Why, When and How?

Eriksson

Wadelius

2012

Pharmacogenomics

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“…A relatively large number of studies that evaluated the performance of genotype‐guided warfarin dosing algorithms in populations of Asian ancestry have been published (Table ) . These studies were conducted primarily in individuals from China, Korea, and Japan, with virtually no studies from Asian populations within the United States.…”

Section: Genotype‐guided Warfarin Dosing Algorithms In Diverse Populamentioning

confidence: 99%

Warfarin Pharmacogenomics in Diverse Populations

et al. 2017

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Genotype-guided warfarin dosing algorithms are a rational approach to optimize warfarin dosing and potentially reduce adverse drug events. Diverse populations, such as African Americans and Latinos, have greater variability in warfarin dose requirements and are at greater risk for experiencing warfarinrelated adverse events compared with individuals of European ancestry. Although these data suggest that patients of diverse populations may benefit from improved warfarin dose estimation, the vast majority of literature on genotype-guided warfarin dosing, including data from prospective randomized trials, is in populations of European ancestry. Despite differing frequencies of variants by race/ethnicity, most evidence in diverse populations evaluates variants that are most common in populations of European ancestry. Algorithms that do not include variants important across race/ethnic groups are unlikely to benefit diverse populations. In some race/ethnic groups, development of race-specific or admixture-based algorithms may facilitate improved genotype-guided warfarin dosing algorithms above and beyond that seen in individuals of European ancestry. These observations should be considered in the interpretation of literature evaluating the clinical utility of genotype-guided warfarin dosing. Careful consideration of race/ethnicity and additional evidence focused on improving warfarin dosing algorithms across race/ethnic groups will be necessary for successful clinical implementation of warfarin pharmacogenomics. The evidence for warfarin pharmacogenomics has a broad significance for pharmacogenomic testing, emphasizing the consideration of race/ethnicity in discovery of gene-drug pairs and development of clinical recommendations for pharmacogenetic testing.

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“…These factors could explain 50% of the total warfarin dose variation. On the basis of these factors, various retrospective studies have established genotype‐guided predictive algorithms through multiple linear regression analysis; such algorithms can effectively predict the patient's warfarin stable dosage (WSD) . However, the results of the latest prospective studies suggested that whether pharmacogenetics‐based algorithms are benefit for initiation of anticoagulation with warfarin was still controversial.…”

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confidence: 99%

Effect of CYP2C9–VKORC1 interaction on warfarin stable dosage and its predictive algorithm

Liu

Yan

et al. 2014

The Journal of Clinical Pharma

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This study aimed to identify the effect of CYP2C9-VKORC1 interaction on warfarin dosage requirement and its predictive algorithm by investigating four populations. Generalized linear model was used to evaluate the relationship between the interaction and warfarin stable dosage (WSD), whereas multiple linear regression analysis was applied to construct the WSD predictive algorithm. To evaluate the effect of CYP2C9-VKORC1 interaction on the predictive algorithms, we compared the algorithms with and without the interaction. The interaction was significantly associated with WSD in the Chinese and White cohorts (P values < 0.05). In the algorithms that considered the interaction, the predictive success rates improved by only 0.12% in the Chinese patients and by a maximum of 0.02% in the White patients under four different CYP2C9 classifications. Thus, VKORC1-CYP2C9 interaction can affect WSD. However, the discrepancy between the predictive results obtained using the predictive algorithm with and without CYP2C9-VKORC1 interaction was negligible and can therefore be disregarded.

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Development and Comparison of a Warfarin-Dosing Algorithm for Korean Patients With Atrial Fibrillation

Cited by 32 publications

References 42 publications

Prediction of Warfarin Dose: Why, When and How?

Prediction of Warfarin Dose: Why, When and How?

Warfarin Pharmacogenomics in Diverse Populations

Effect of CYP2C9–VKORC1 interaction on warfarin stable dosage and its predictive algorithm

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