Non-genetic factors and polymorphisms in genes CYP2C9 and VKORC1: predictive algorithms for TTR in Brazilian patients on warfarin

Praxedes, Marcus Fernando da Silva; Martins, Maria Auxiliadora Parreiras; Mourão, Aline O M; Gomes, Karina Braga; Reis, Edna Afonso; Souza, Renan P.; Campos, Emílio Itamar F; Ribeiro, Daniel Dias; Rocha, Manoel Otávio Costa

doi:10.1007/s00228-019-02772-4

Cited by 8 publications

(17 citation statements)

References 49 publications

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“…Twenty-two studies met the inclusion criteria of this systematic review and were selected for qualitative synthesis and metaanalysis. 15,16,[25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44] No unpublished study on the topic was found. We performed a manual search and screened the grey literature without identifying any study meeting the eligibility criteria.…”

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

“…The number of participants ranged from 110 to 104 505, in aggregate (183 612; women: 45%). The lowest measurement of central tendency for age was mean age of 57 years in 15 studies 15,16,[25][26][27][28][29][30][31][32][33]36,39,41,42 and median age of 55 years in four studies, 37,38,40,43 and the three remaining presented only age categories. 34,35,44 The main indication of long-term oral anticoagulation was AF.…”

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

“…There was also a variation in sex-related TTR in the studies. No significant difference in TTR between men and women was observed in 11 studies, 16,25,26,29,31,35,[38][39][40][41][42] and 10 studies 15,27,28,30,[32][33][34]36,37,44 reported female association with lower TTR than males and one study found association between the female sex and higher TTR 43 (Table 1).…”

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

“…Regarding the observational design, two studies 27,34 were classified as high quality using the Newcastle-Ottawa Scale. 21 Twelve studies were considered as of medium quality, 15,25,30,31,33,35,[37][38][39]41,42,44 and two studies were classified as having low quality 29,36 (Table 2).…”

Section: Search Results and Study Characteristicsmentioning

confidence: 99%

“…12 Previous investigations on factors associated with anticoagulation control have shown a relationship between TTR and sex, albeit with conflicting evidence. Some authors reported an association of females with poorer TTR, although others found poorer TTR in men [13][14][15] or no association of oral anticoagulation control with sex. 16,17 Sex-related aspects that may affect TTR, such as behavioural and physiological factors, are not fully understood.…”

Section: Introductionmentioning

confidence: 99%

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Sex‐influence on the time in therapeutic range (TTR) during oral anticoagulation with coumarin derivatives: Systematic review and meta‐analysis

Viana

Praxedes

Sousa

et al. 2021

Brit J Clinical Pharma

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Aims: We sought to investigate the association between sex and oral anticoagulation control employing coumarin derivatives.Methods: Electronic sources were MEDLINE, Biblioteca Virtual em Saúde (BVS), The Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Cochrane Central and Web of Science. Inclusion criteria were: observational and experimental studies; age ≥18 years; both sexes; treatment with any coumarin derivative for ≥3 months; any indication of long-term use; quality of oral anticoagulation measured by time in therapeutic range (TTR). The meta-analysis was developed with odds ratios (OR) for binary variables and mean differences (MD) for continuous variables, using random-effects models (DerSimonian and Laird) with 95% confidence intervals (CI).Results: Overall, 22 articles were selected, comprising 16 cohort studies, four crosssectional studies and two clinical trials. The number of participants ranged from 110 to 104 505 (183 612; women: 45%). The main indication of oral anticoagulation was atrial fibrillation. Most studies reported the use of warfarin. In the meta-analysis, 15 studies were analysed using TTR as a binary variable (OR = 0.87; 95% CI = 0.78, 0.96; z = À2.75; P = .006.; I 2 = 67%) and seven studies as a continuous variable (MD = À2.97; 95% CI = À4.80, À1.14; z = À3.19; P = .0014; I 2 = 75%). The pooled estimates indicated that women were associated with lower TTR than men.Conclusions: Our findings revealed an association between female sex and worse oral anticoagulation control. Further studies are needed with primary design to investigate sex-related factors influencing oral anticoagulation control with coumarin derivatives. Innovative strategies focused on women's health may be useful to improve patient-centred care.

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