Validation and comparison of warfarin stable dosage prediction algorithms in Chinese patients undergoing heart valve replacement

Abstract

Abstract: AIM: To validate and compare 12 previously published warfarin stable dosage prediction algorithms and the fixed dosing regimen (2.5 mg/d) as applied to our patients undergoing heart valve replacement (HVR). METHODS: 804 Chinese HVR patients on stable maintenance dose of warfarin were enrolled from our hospital. Comprehensive clinical data were collected. 2 mL blood sample was drawn from each patient for VKORC1-1639G>A and CYP2C9^*3 genotype analyses by pyrosequencing method. 12 previously published algorithms were selected from Pubmed database for validation and comparison. The performance of all the algorithms was determined by mean absolute error (MAE) and percentage of ideal/under/over prediction.RESULTS: 9 algorithms and the fixed dosing method showed a MAE less than±1.0 mg/d, of which the Gage, Wen and Ohno algorithms had the lowest MAE. 8 algorithms and the fixed dosing regimen showed more than 40% of ideal prediction, of which the Wen, Huang and Gage algorithms showed the highest percentage of ideal prediction. Sensitivity analysis demonstrated that these algorithms had better prediction for the medium-dose (>1.88 and <4.38 mg/d) and high-dose (≥4.38 mg/d) patients but showed poor performance for the low-dose (≤1.88 mg/d) patients.The ideal prediction of the fixed dosing regimen for both low-dose and high-dose patients was 0.CONCLUSION: Genotype-guided warfarin dosage prediction algorithms could accurately predict most of our patients, therefore these algorithms may be potentially useful in clinical practice.

Key words: Warfarin, Algorithms, VKORC1, CYP2C9

CLC Number:

R969

TAN Sheng-lan, PENG Juan, ZHOU Xin-min, SONG Guo-bao, LIU Li-ming, ZHANG Wei, LIU Zhao-qian, ZHOU Hong-hao, LI Zhi. Validation and comparison of warfarin stable dosage prediction algorithms in Chinese patients undergoing heart valve replacement[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2012, 17(9): 1026-1033.

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