Clinical verification of Lou type warfarin pharmacokinetic dosing algorithms equation

• Published in: Molecular medicine reports Vol. 17; no. 4; pp. 6144 - 6149
• Main Authors: Jiang, Jiangang, Ji, Ningning, Lan, Jingliang, Ge, Xiaoping, Du, Xiaoma
• Format: Journal Article
• Language: English
• Published: Greece Spandidos Publications UK Ltd 01.04.2018
• Subjects: Age; Aged; Algorithms; Alleles; Anticoagulants - administration & dosage; Anticoagulants - adverse effects; Anticoagulants - pharmacokinetics; Blood; Blood levels; Cardiac arrhythmia; Chinese medicine; Cytochrome; Cytochrome P-450 Enzyme System - genetics; Cytochrome P-450 Enzyme System - metabolism; Deoxyribonucleic acid; DNA; Drug dosages; Eating behavior; Embolisms; Female; Genotype; Hospitals; Humans; Laboratories; Male; Middle Aged; Patients; Pharmacogenetics; Pharmacogenetics - methods; Pharmacokinetics; Sequence Analysis, DNA; Side effects; Studies; Substance abuse treatment; Thrombosis; Warfarin; Warfarin - administration & dosage; Warfarin - adverse effects; Warfarin - pharmacokinetics; China
• ISSN: 1791-2997; 1791-3004
• DOI: 10.3892/mmr.2018.8562

Warfarin is the most commonly used oral anti-coagulant in clinic practice. However, it is difficult to recommend the correct dosage due to its narrow therapeutic window. The aim of the present study was to verify the clinical value of the Lou type equation, using pharmacogenetics‑based warfarin dosing algorithms to appropriately predict the actual maintenance dose. A total of 87 Chinese Han patients who required treatment with warfarin were enrolled and randomly divided into the experimental and control groups. In the experimental group, the first 3 doses of warfarin were calculated according to the Lou type equation. While in the control group, these 3 treatments were performed following the doctors' recommendations. Then the dose of warfarin was gradually adjusted to the stable dose according to the changes in the international standardized ratio. At the end of the 50 day experimental period, there were a greater number of patients in the experimental group who exhibited a stable blood concentration of warfarin than those in the control group (83.35 and 64.4%, respectively). In addition, the mean and median times for patients to obtain a stable dose in the experimental group were significantly shorter than those in the control group (mean, 18.2±1.7 and 27.3±2.0 days; and median, 11.7±1.1 and 20.5±1.8 days, respectively). The adverse reaction rate of the experimental group (9.5%) was markedly lower than that of the control group (26.7%). The occurrence of adverse reactions in the experimental group was also significantly later when compared with the control group (43.9±1.6 and 38.6±1.5 days, respectively). Furthermore, there was no significant difference between the average predicted dose (3.4±1.1 mg/day) and the average actual dose (3.5±1.4 mg/day; P=0.313). In conclusion, using the Lou type warfarin pharmacokinetic dosing algorithm equation to administer warfarin markedly shortened the adjustment time of warfarin to reach a stable dose and reduced the adverse reactions rate, thus supporting clinical feasibility.