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Pharmacogenetic-guided and standard dosing did not differ for out-of-range INRs in patients initiating warfarin therapy

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J L Anderson

Dr J L Anderson, Intermountain Medical Center, Murray, UT, USA; erson@intermountainmail.org

STUDY DESIGN

Design:

randomised controlled trial (RCT).

Allocation:

unclear allocation concealment.*

Blinding:

blinded (clinicians and patients).*

STUDY QUESTION

Setting:

anticoagulation clinic at Intermountain Healthcare, Utah, United States.

Patients:

206 patients 18–86 years of age (mean age 61 y, 53% men, based on 200 patients) in whom anticoagulation with a target international normalised ratio (INR) range of 2–3 was indicated. Exclusion criteria included pregnancy, lactation, and comorbidities precluding standard dosing (eg, advanced physiological age, serum creatinine level >2.5 mg/dl, hepatic insufficiency, and terminal disease).

Intervention:

warfarin initiation with pharmacogenetic-guided dosing (PGD, n = 101) or standard dosing (SD, n = 99). PGD was based on a regression equation that included genotype, age, sex, and weight and generated scores in 14 dose increments from 1–8 mg/day; twice the dose was given on the first 2 days, and subsequent dose modification was based on INR. SD was …

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