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Efficacy and Safety of Genotype-Guided Warfarin Dosing in the Chinese Population: A Meta-analysis of Randomized Controlled Trials.
Journal of Cardiovascular Pharmacology 2019 January 26
AIMS: To evaluate the efficacy and safety of using genetic information to guide warfarin dosing in the Chinese population.
METHODS: This meta-analysis was conducted among the published, randomized, controlled trials (RCTs) in the Chinese population comparing genotyped-guided warfarin dosing (PG group) with clinical or standard warfarin dosing (STD group). RCTs published on or before January 2018 were identified using the PubMed, Embase, Cochrane Library, CNKI, Chinese VIP database and Chinese Wanfang databases.
RESULT: The 2,137 participants from 14 RCTs were included in the meta-analysis. Primary analysis showed that both bleeding events (OR=0.24, 95% CI, 0.11 to 0.52, P=0.0003) and adverse events (OR=0.60, 95% CI, 0.43 to 0.83, P=0.002) were significantly lower in the genotyped-guided group than in the clinical or standard group. The percentage of patients who received a warfarin-stable therapeutic dose during follow-up was increased in the genotyped-guided groupcompared to the percentage in the clinical or standard group (OR=2.68, 95% CI,1.82 to 3.95, P<0.00001). In the genotyped-guided group, the time to a stabletherapeutic dose (MD=-7.98, 95% CI, -9.08 to -6.87, p<0.00001) and the time to the first target value (MD=-1.87, 95% CI, -3.41 to -0.32, P=0.02) were shortened compared with those of the clinical or standard group, but there was nodifference for INR>4, between the two groups (OR=0.42, 95% CI, 0.14 to 1.25, P=0.12).
CONCLUSION: Genotype-guided warfarin dosing algorithms could improve the efficacy and safety of warfarin anticoagulation in the Chinese population.
METHODS: This meta-analysis was conducted among the published, randomized, controlled trials (RCTs) in the Chinese population comparing genotyped-guided warfarin dosing (PG group) with clinical or standard warfarin dosing (STD group). RCTs published on or before January 2018 were identified using the PubMed, Embase, Cochrane Library, CNKI, Chinese VIP database and Chinese Wanfang databases.
RESULT: The 2,137 participants from 14 RCTs were included in the meta-analysis. Primary analysis showed that both bleeding events (OR=0.24, 95% CI, 0.11 to 0.52, P=0.0003) and adverse events (OR=0.60, 95% CI, 0.43 to 0.83, P=0.002) were significantly lower in the genotyped-guided group than in the clinical or standard group. The percentage of patients who received a warfarin-stable therapeutic dose during follow-up was increased in the genotyped-guided groupcompared to the percentage in the clinical or standard group (OR=2.68, 95% CI,1.82 to 3.95, P<0.00001). In the genotyped-guided group, the time to a stabletherapeutic dose (MD=-7.98, 95% CI, -9.08 to -6.87, p<0.00001) and the time to the first target value (MD=-1.87, 95% CI, -3.41 to -0.32, P=0.02) were shortened compared with those of the clinical or standard group, but there was nodifference for INR>4, between the two groups (OR=0.42, 95% CI, 0.14 to 1.25, P=0.12).
CONCLUSION: Genotype-guided warfarin dosing algorithms could improve the efficacy and safety of warfarin anticoagulation in the Chinese population.
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