Pharmacist-Led Genotype-Guided Warfarin Therapy in Valve Replacement: An Observation Cohort Study.

INTRODUCTION

Our study aimed to compare the impact of pharmacist-led genotype-guided warfarin dosing with the traditional dosing regimen on the anticoagulation effect for patients undergoing valve replacement.

METHODS

A total of 453 patients were divided into genotype-guided and traditional dosing groups. Blood samples were obtained for genotyping and determination of warfarin dosing by an algorithm in the genotype group, while a regular dose was administered in the traditional group.

RESULTS

Genotype-guided dosing could significantly enhance the percentage of time within the target international normalized ratio range in comparison to traditional dosing during the first two and three follow-up months (57.2% ± 5.0% versus 56.2% ± 5.0%, 95% confidence interval: 0.7%-2.4%, P = 0.033 and 62.9% ± 4.9% versus 61.7% ± 6.0%, 95% confidence interval: 0.6%-3.1%, P = 0.024, respectively). Patients undergoing genotype-guided dosing could achieve a stable maintenance dose in a shorter period of time (P = 0.034) compared to the traditional dosing group. Genotype-guided therapy reduced the occurrence of bleeding and thrombosis complications, but no significant differences were observed.

CONCLUSIONS

Our study revealed that a pharmacist-led genotype-guided warfarin dosing strategy could improve the effectiveness of anticoagulant therapy for valve replacement operations.