Validation of a Proposed Warfarin Dosing Algorithm Based on the Genetic Make-Up of Egyptian Patients

Ekladious, Sherif; Issac, Marianne Samir M.; Sharaf, Sahar A.; Abou-Youssef, Hazem S.

doi:10.1007/s40291-013-0046-3

Cited by 20 publications

(13 citation statements)

References 49 publications

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“…This is probably due to the sample size, and to the absence of CYP2C9 low-activity genotypes (i.e., *2/*2, *3/*3 and *2/*3). Accordingly, previous studies with similar sample sizes failed to replicate the CYP2C9 effect on a warfarin dose [39]. Nevertheless, since the VKORC1 genotype has a greater effect on the warfarin dose than those reported for CYP2C9 (30 vs 10%), and the VKORC1 minor allele frequency is high in the Turkish population, we replicated the VKORC1 finding in our controlled patients (R 2 = 29.12%).…”

Section: Discussionsupporting

confidence: 83%

International Warfarin Genotype-Guided Dosing Algorithms in the Turkish Population and Their Preventive Effects on Major and Life-Threatening Hemorrhagic Events

Karaca

Bozkurt

Cesuroğlu³

et al. 2015

Pharmacogenomics

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Section: Discussionsupporting

confidence: 83%

International Warfarin Genotype-Guided Dosing Algorithms in the Turkish Population and Their Preventive Effects on Major and Life-Threatening Hemorrhagic Events

Karaca

Bozkurt

Cesuroğlu³

et al. 2015

Pharmacogenomics

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“…In agreement with our data, Ekladious et al [14] developed a similar model in a cohort of Egyptian patients including the variables -age, gender, CYP2C9, and VKORC1 SNP genotypes. Regression analysis revealed that age and VKORC1 contributed independently to the overall variability in warfarin dose.…”

Section: Discussionsupporting

confidence: 91%

“…Furthermore, data from previous reports addressing the value of pharmacogenetic testing in warfarin management in Egyptian patients were infrequent, controversial, and included different polymorphisms [13,14]. The aim of this study was to demonstrate the validity of pharmacogenetic dosing algorithms in Egyptian patients on warfarin therapy.…”

Section: Introductionmentioning

confidence: 98%

Pharmacogenetic Warfarin Dosing Algorithms: Validity in Egyptian Patients

et al. 2018

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Background/Aims: Data from previous reports, addressing the significance of genotype-guided dosing of warfarin in Egyptian patients, are infrequent and controversial. This study is aimed at demonstrating the validity of genetic dosing algorithms in Egyptian patients on warfarin therapy. Methods: A total of 100 Egyptian patients on a stable maintenance daily dose of warfarin were enrolled. The predicted warfarin dose for each patient was calculated using the warfarin dosing table, the Gage and the International Warfarin Pharmacogenetics Consortium (IWPC) clinical algorithms and the Gage and the IWPC genetic algorithms and compared to the actual dose. The accuracy of warfarin dosing algorithms was assessed by using the linear regression analysis. Results: The most accurate model in predicting the ideal dose was the Gage genetic algorithm by R² of 50.4% and the IWPC genetic algorithm by R² of 42.3%, followed by the warfarin dosing table by R² of 19.1%, and the Gage clinical algorithm by R² of 18.9% and the least accurate was the IWPC clinical algorithm by R² of 9.4%. Conclusions: The Gage genetic warfarin dosing algorithm is the best model that could be implemented in Egyptian patients starting warfarin therapy.

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“…The use of algorithms based on pharmacogenetics for individualization of dose regimen for warfarin is described by several authors, [22][23][24][25] since genotype is the main determinant of the required warfarin dose and the risk of bleeding, especially in the early months of therapy. 26 Clinical studies have shown that the use of genotype to determine warfarin dose generates variability of results, especially because of the complexity of interrelations between genetic and non-genetic factors.…”

Section: Algorithms Evaluationmentioning

confidence: 99%

Algorithms for monitoring warfarin use: Results from Delphi Method

Kano

Borges

Scomparini

et al. 2017

Rev. Assoc. Med. Bras.

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Warfarin stands as the most prescribed oral anticoagulant. New oral anticoagulants have been approved recently; however, their use is limited and the reversibility techniques of the anticoagulation effect are little known. Thus, our study's purpose was to develop algorithms for therapeutic monitoring of patients taking warfarin based on the opinion of physicians who prescribe this medicine in their clinical practice. The development of the algorithm was performed in two stages, namely: (i) literature review and (ii) algorithm evaluation by physicians using a Delphi Method. Based on the articles analyzed, two algorithms were developed: "Recommendations for the use of warfarin in anticoagulation therapy" and "Recommendations for the use of warfarin in anticoagulation therapy: dose adjustment and bleeding control." Later, these algorithms were analyzed by 19 medical doctors that responded to the invitation and agreed to participate in the study. Of these, 16 responded to the first round, 11 to the second and eight to the third round. A 70% consensus or higher was reached for most issues and at least 50% for six questions. We were able to develop algorithms to monitor the use of warfarin by physicians using a Delphi Method. The proposed method is inexpensive and involves the participation of specialists, and it has proved adequate for the intended purpose. Further studies are needed to validate these algorithms, enabling them to be used in clinical practice.

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Validation of a Proposed Warfarin Dosing Algorithm Based on the Genetic Make-Up of Egyptian Patients

Cited by 20 publications

References 49 publications

International Warfarin Genotype-Guided Dosing Algorithms in the Turkish Population and Their Preventive Effects on Major and Life-Threatening Hemorrhagic Events

International Warfarin Genotype-Guided Dosing Algorithms in the Turkish Population and Their Preventive Effects on Major and Life-Threatening Hemorrhagic Events

Pharmacogenetic Warfarin Dosing Algorithms: Validity in Egyptian Patients

Algorithms for monitoring warfarin use: Results from Delphi Method

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