机构:[1]The Department of Laboratory Medicine, Peking University Third Hospital[2]The Department of Clinical Laboratory Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health医技科室职能科室临床流行病与循证医学中心临床研究中心首都医科大学附属北京儿童医院[3]The Department of Laboratory Medicine, Peking University People’s Hospital, Beijing, PR China.
Warfarin is the most common oral anticoagulant. Because of a narrow therapeutic range, interindividual differences in drug responses, and the risk of bleeding, there are many challenges in using warfarin. We need to predict the warfarin maintenance dose. However, ethnic-specific algorithms may be required, and some Chinese algorithms do not perform adequately. Therefore, we aimed to establish a Han Chinese appropriate algorithm. We recruited a study group consisting of 361 Han Chinese patients receiving warfarin treatment who had heart valve replacements. Genotyping of 38 single nucleotide polymorphisms (SNPs) in 13 candidate genes was carried out using the MassARRAY. In the derivation cohort, a multiple linear regression model was constructed to predict the warfarin dosage. We evaluated the accuracy of our algorithm in the validation cohort and compared it with the other 5 algorithms based on Han Chinese and other races. We established a Han Chinese-specific pharmacogenetic-guided warfarin dosing algorithm. Warfarin maintenance dosage (mg/day) = 1.787 - 0.023 x (Age) + 1.151 x (BSA [m(2)]) + 0.917 x (VKORC1 AG) + 4.619 x (VKORC1 GG) + 0.595 x (CYP4F2 TT) + 0.707 x (CYP2C19 CC). It explained 58.3% of the variance in warfarin doses in Han Chinese patients and was superior to the other 5 algorithms. The ability of the 6 algorithms which estimate the required dose correctly was tested. Our model had a mean absolute error of 0.74 mg/day, the other 5 models have mean absolute error of 0.81 mg/day, 1.05 mg/day, 1.24 mg/day, 1.18 mg/day, and 0.85 mg/day, respectively. Our model had a mean percentage error of 26.9%, the other 5 models have the mean percentage error of 27.7%, 27.2%, 52.3%, 45.7%, and 29.3%, respectively. Physicians can not adopt algorithm from other race directly to predict warfarin dose in patients with heart valve replacements, they should establish a new algorithm or adjust another algorithm to fit their patients. The algorithm established in this study has the potential to assist physicians in determining warfarin doses that are close to the appropriate doses.
基金:
Beijing Municipal Science & Technology CommissionBeijing Municipal Science & Technology Commission [2107000093]
第一作者机构:[1]The Department of Laboratory Medicine, Peking University Third Hospital
通讯作者:
通讯机构:[1]The Department of Laboratory Medicine, Peking University Third Hospital[*1]The Department of Laboratory Medicine, Peking University Third Hospital, #49 Huayuanbei Road, Haidian, Beijing 100191, PR China
推荐引用方式(GB/T 7714):
Pei Lin,Tian Xiaoyi,Long Yan,et al.Establishment of a Han Chinese-specific pharmacogenetic-guided warfarin dosing algorithm[J].MEDICINE.2018,97(36):-.doi:10.1097/MD.0000000000012178.
APA:
Pei, Lin,Tian, Xiaoyi,Long, Yan,Nan, Wenhui,Jia, Mei...&Zhang, Jie.(2018).Establishment of a Han Chinese-specific pharmacogenetic-guided warfarin dosing algorithm.MEDICINE,97,(36)
MLA:
Pei, Lin,et al."Establishment of a Han Chinese-specific pharmacogenetic-guided warfarin dosing algorithm".MEDICINE 97..36(2018):-