title: Prediction of optimal warfarin maintenance dose using advanced artificial neural networks.
abstract: BACKGROUND
  In recent years, pharmacogenetic algorithms were developed for estimating the appropriate dose of vitamin K antagonists.
  
  
  OBJECTIVE
  To evaluate the performance of new generation artificial neural networks (ANNs) to predict the warfarin maintenance dose.
  
  
  METHODS
  Demographic, clinical and genetic data (CYP2C9 and VKORC1 polymorphisms) from 377 patients treated with warfarin were used. The final prediction model was based on 23 variables selected by TWIST® system within a bipartite division of the data set (training and testing) protocol.
  
  
  RESULTS
  The ANN algorithm reached high accuracy, with an average absolute error of 5.7 mg of the warfarin maintenance dose. In the subset of patients requiring ≤21 mg and 21-49 mg (45 and 51% of the cohort, respectively) the absolute error was 3.86 mg and 5.45 with a high percentage of subjects being correctly identified (71 and 73%, respectively).
  
  
  CONCLUSIONS
  ANN appears to be a promising tool for vitamin K antagonist maintenance dose prediction.
authors: Centro Diagnostico Italiano, Milan, Italy.
authors: Enzo
authors: E
authors: Grossi
authors: Gian Marco
authors: GM
authors: Podda
authors: Mariateresa
authors: M
authors: Pugliano
authors: Silvia
authors: S
authors: Gabba
authors: Annalisa
authors: A
authors: Verri
authors: Giovanni
authors: G
authors: Carpani
authors: Massimo
authors: M
authors: Buscema
authors: Giovanni
authors: G
authors: Casazza
authors: Marco
authors: M
authors: Cattaneo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics; D065729:Cytochrome P-450 CYP2C9; D004305:Dose-Response Relationship, Drug; D054796:Drug Dosage Calculations; D005260:Female; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D016571:Neural Networks, Computer; D011110:Polymorphism, Genetic; D014812:Vitamin K / Q000008:administration & dosage / Q000037:antagonists & inhibitors*; D064417:Vitamin K Epoxide Reductases / Q000235:genetics; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D014812:Vitamin K; D014859:Warfarin; C450260:CYP2C9 protein, human; D065729:Cytochrome P-450 CYP2C9; D001189:Aryl Hydrocarbon Hydroxylases; C578523:VKORC1 protein, human; D064417:Vitamin K Epoxide Reductases