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- Title
Use of pharmacogenetic and clinical factors to predict the therapeutic dose of warfarin.
- Authors
Gage, B F; Eby, C; Johnson, J A; Deych, E; Rieder, M J; Ridker, P M; Milligan, P E; Grice, G; Lenzini, P; Rettie, A E; Aquilante, C L; Grosso, L; Marsh, S; Langaee, T; Farnett, L E; Voora, D; Veenstra, D L; Glynn, R J; Barrett, A; McLeod, H L
- Abstract
Initiation of warfarin therapy using trial-and-error dosing is problematic. Our goal was to develop and validate a pharmacogenetic algorithm. In the derivation cohort of 1,015 participants, the independent predictors of therapeutic dose were: VKORC1 polymorphism -1639/3673 G>A (-28% per allele), body surface area (BSA) (+11% per 0.25 m(2)), CYP2C9(*)3 (-33% per allele), CYP2C9(*)2 (-19% per allele), age (-7% per decade), target international normalized ratio (INR) (+11% per 0.5 unit increase), amiodarone use (-22%), smoker status (+10%), race (-9%), and current thrombosis (+7%). This pharmacogenetic equation explained 53-54% of the variability in the warfarin dose in the derivation and validation (N= 292) cohorts. For comparison, a clinical equation explained only 17-22% of the dose variability (P < 0.001). In the validation cohort, we prospectively used the pharmacogenetic-dosing algorithm in patients initiating warfarin therapy, two of whom had a major hemorrhage. To facilitate use of these pharmacogenetic and clinical algorithms, we developed a nonprofit website, http://www.WarfarinDosing.org.
- Publication
Clinical pharmacology and therapeutics, 2008, Vol 84, Issue 3, p326
- ISSN
1532-6535
- Publication type
Journal Article
- DOI
10.1038/clpt.2008.10