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Genotype-guided versus traditional clinical dosing of warfarin in patients of Asian ancestry: a randomized controlled trial

Syn NL 1 , Wong AL 1 , Lee SC 1 , Teoh HL 2 , Yip JWL 3 , Seet RC 2 Show all authors , Yeo WT 3 , Kristanto W 3 , Bee PC 4 , Poon LM 1 , Marban P 1 , Wu TS 5 , Winther MD 6 , Brunham LR 7 , Soong R 8 , Tai BC 9 , Goh BC 10

Affiliations 

  • 1 Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore
  • 2 Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
  • 3 Department of Cardiology, National University Heart Centre, Singapore, Singapore
  • 4 Department of Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
  • 5 Department of Pharmacy, National University Hospital, Singapore, Singapore
  • 6 Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore
  • 7 Translational Laboratory in Genetic Medicine, Agency for Science, Technology and Research, Singapore, Singapore
  • 8 Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
  • 9 Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
  • 10 Department of Haematology-Oncology, National University Cancer Institute, Singapore, Singapore. phcgbc@nus.edu.sg
BMC Med, 2018 07 10;16(1):104.
PMID: 29986700 DOI: 10.1186/s12916-018-1093-8

Abstract

BACKGROUND: Genotype-guided warfarin dosing has been shown in some randomized trials to improve anticoagulation outcomes in individuals of European ancestry, yet its utility in Asian patients remains unresolved.

METHODS: An open-label, non-inferiority, 1:1 randomized trial was conducted at three academic hospitals in South East Asia, involving 322 ethnically diverse patients newly indicated for warfarin (NCT00700895). Clinical follow-up was 90 days. The primary efficacy measure was the number of dose titrations within the first 2 weeks of therapy, with a mean non-inferiority margin of 0.5 over the first 14 days of therapy.

RESULTS: Among 322 randomized patients, 269 were evaluable for the primary endpoint. Compared with traditional dosing, the genotype-guided group required fewer dose titrations during the first 2 weeks (1.77 vs. 2.93, difference -1.16, 90% CI -1.48 to -0.84, P 

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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