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学科主题: 临床医学
题名:
Limited clinical utility of genotype-guided warfarin initiation dosing algorithms versus standard therapy: a meta-analysis and trial sequential analysis of 11 randomized controlled trials
作者: Tang, H. L.1; Shi, W. L.1; Li, X. G.1; Zhang, T.1; Zhai, S. D.1; Xie, H. G.2,3
刊名: PHARMACOGENOMICS JOURNAL
发表日期: 2015-12-01
DOI: 10.1038/tpj.2015.16
卷: 15, 期:6, 页:496-504
收录类别: SCI
文章类型: Article
WOS标题词: Science & Technology
类目[WOS]: Genetics & Heredity ; Pharmacology & Pharmacy
研究领域[WOS]: Genetics & Heredity ; Pharmacology & Pharmacy
关键词[WOS]: ORAL ANTICOAGULATION ; BLEEDING COMPLICATIONS ; ATRIAL-FIBRILLATION ; PHARMACOGENETICS ; CYP2C9 ; MORTALITY ; STROKE ; VKORC1
英文摘要:

In terms of inconsistent conclusions across all relevant randomized controlled trials (RCTs) and available meta-analyses, we aimed to use a meta-analysis and trial sequential analysis (TSA) to evaluate whether clinical utility of a genotype-guided warfarin initiation dosing algorithm could be better than that of a standard therapy regimen, and whether currently relevant evidence could be reliable and conclusive. Overall, 11 eligible RCTs involving 2677 patients were included for further analyses. Compared with fixed dose or clinically adjusted warfarin initiation dosing regimens, genotype-guided algorithms significantly increased time in therapeutic range, shortened time to first therapeutic international normalized ratio (INR) and time to stable doses, but did not show any marked improvements in excessive anticoagulation, bleeding events, thromboembolism, or all-cause mortality. Subgroup analyses revealed that, genotype-guided algorithms showed better control in the outcomes of time in therapeutic range or excessive anticoagulation than fixed-dose regimens rather than clinically adjusted regimens. Except for excessive anticoagulation, currently available evidence of all other outcomes was unreliable and inconclusive as determined with TSA. Our findings suggest that genotype-guided warfarin initiation dosing algorithms have superiority in the improvement of surrogate quality markers for anticoagulation control, but that this does not translate into statistically significant differences in clinical outcomes, which is largely because of the insufficient sample size in the RCTs analyzed.

语种: 英语
所属项目编号: BL2013001 ; BK2012525
项目资助者: Department of Science and Technology of Jiangsu Province ; Natural Science Foundation of Jiangsu Province, China
WOS记录号: WOS:000366127600003
Citation statistics:
内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/61412
Appears in Collections:北京大学第三临床医学院_药剂科_期刊论文

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作者单位: 1.Peking Univ, Hosp 3, Dept Pharm, Therapeut Drug Monitoring & Clin Toxicol Ctr, Beijing 100871, Peoples R China
2.Nanjing Med Univ, Nanjing Hosp 1, GCRC, Nanjing 210006, Jiangsu, Peoples R China
3.Nanjing Med Univ, Sch Pharm, Dept Pharmacol, Nanjing, Jiangsu, Peoples R China

Recommended Citation:
Tang, H. L.,Shi, W. L.,Li, X. G.,et al. Limited clinical utility of genotype-guided warfarin initiation dosing algorithms versus standard therapy: a meta-analysis and trial sequential analysis of 11 randomized controlled trials[J]. PHARMACOGENOMICS JOURNAL,2015,15(6):496-504.
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