Pulmonary Vascular Disease: Pulmonary Vascular Disease: VTE |

A Randomized Controlled Study of the VKORC1 and CYP2C9 Genotypes in Guiding Warfarin Initial Dosing Algorithm for Pulmonary Thromboembolism FREE TO VIEW

Linli Duan, MD; Nuofu Zhang, MD; Chunli Liu, PhD
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State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A519. doi:10.1016/j.chest.2016.02.541
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SESSION TITLE: Pulmonary Vascular Disease: VTE

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Saturday, April 16, 2016 at 11:45 AM - 12:45 PM

PURPOSE: To evaluate the clinical application of warfarin dosing algorithm by VKORC1 and CYP2C9 genotypes in prediction of warfarin initial dose in patients with pulmonary thromboembolism.

METHODS: During March 2014 and July 2015,55 patients diagnosed with pulmonary embolism with/without deep venous thrombosis in the First Affiliated Hospital of Guangzhou Medical University were enrolled by the inclusion criteria. Those patients were randomly divided into a experimental group and a control group, including 25 and 30 cases respectively. 23 cases of 55 patients with male. The average age was (54.45±14.85). Classification of Pulmonary embolism low-risk (31), intermediate (19), high (5). In the experimental group, patients were detected the genotypes of VKORC1 and CYP2C9 When the first day of the diagnosis of pulmonary thromboembolism. Clinical laboratory doctor calculated the initial doses of warfarin. While in the control group, patients’warfarin therapy were performed by tradictional model. The frequency of INR monitoring was one time every day from the third day of initial warfarin therapy to leave hospital, one time every week after discharge, and one time every month after stable dose acquired, and the following-up lasted for 4 weeks.

RESULTS: The percentage of patients who obtained the third consecutive target values of INR in the experimental group and control group was 64% (n=16), 43.3% (n=13), respectively. Over anticoagulation incidence was 36% (n=9), 43.3% (n=13). Unfortunately, there were no significant difference between the two groups. However, experimental group had no bleeding and recurrence of thrombosis, while there were 4 patients in the control group, one of them died from recurrent thrombosis.

CONCLUSIONS: The detection of CYP2C9/VKORC1 genotype in patients who were administrated with warfarin reveals a decline on bleeding and thrombosis recurrence rate. Following up to 4 weeks, the proportion that patients still insist on reviewing coagulation function is low, as well as the control rates, and the compliance was poor. Of course, probably because of the small sample sizes, we need to recruit more subjects to confirm this conclusion.

CLINICAL IMPLICATIONS: Detection of warfarin gene polymorphisms, which predicts initial dosage of warfarin, may does not help much to the patients, and the high cost of detection makes it difficult to spread over nearly all hospitals. So a novel, oral anticoagulant which can be prescribed on a fixed dosage must be gospel to such kind of patients.

DISCLOSURE: The following authors have nothing to disclose: Linli Duan, Nuofu Zhang, Chunli Liu

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