title: Verification of pharmacogenetics-based warfarin dosing algorithms in Han-Chinese patients undertaking mechanic heart valve replacement.
abstract: OBJECTIVE
  To study the performance of pharmacogenetics-based warfarin dosing algorithms in the initial and the stable warfarin treatment phases in a cohort of Han-Chinese patients undertaking mechanic heart valve replacement.
  
  
  METHODS
  We searched PubMed, Chinese National Knowledge Infrastructure and Wanfang databases for selecting pharmacogenetics-based warfarin dosing models. Patients with mechanic heart valve replacement were consecutively recruited between March 2012 and July 2012. The predicted warfarin dose of each patient was calculated and compared with the observed initial and stable warfarin doses. The percentage of patients whose predicted dose fell within 20% of their actual therapeutic dose (percentage within 20%), and the mean absolute error (MAE) were utilized to evaluate the predictive accuracy of all the selected algorithms.
  
  
  RESULTS
  A total of 8 algorithms including Du, Huang, Miao, Wei, Zhang, Lou, Gage, and International Warfarin Pharmacogenetics Consortium (IWPC) model, were tested in 181 patients. The MAE of the Gage, IWPC and 6 Han-Chinese pharmacogenetics-based warfarin dosing algorithms was less than 0.6 mg/day in accuracy and the percentage within 20% exceeded 45% in all of the selected models in both the initial and the stable treatment stages. When patients were stratified according to the warfarin dose range, all of the equations demonstrated better performance in the ideal-dose range (1.88-4.38 mg/day) than the low-dose range (<1.88 mg/day). Among the 8 algorithms compared, the algorithms of Wei, Huang, and Miao showed a lower MAE and higher percentage within 20% in both the initial and the stable warfarin dose prediction and in the low-dose and the ideal-dose ranges.
  
  
  CONCLUSIONS
  All of the selected pharmacogenetics-based warfarin dosing regimens performed similarly in our cohort. However, the algorithms of Wei, Huang, and Miao showed a better potential for warfarin prediction in the initial and the stable treatment phases in Han-Chinese patients undertaking mechanic heart valve replacement.
authors.affiliation: Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, P. R. China.
authors.forename: Li
authors.initials: L
authors.lastname: Zhao
authors.affiliation: Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, P. R. China.
authors.forename: Chunxia
authors.initials: C
authors.lastname: Chen
authors.affiliation: Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, P. R. China.
authors.forename: Bei
authors.initials: B
authors.lastname: Li
authors.affiliation: Department of Cardiothoracic Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China.
authors.forename: Li
authors.initials: L
authors.lastname: Dong
authors.affiliation: Department of Cardiothoracic Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China.
authors.forename: Yingqiang
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Department of Cardiothoracic Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China.
authors.forename: Xijun
authors.initials: X
authors.lastname: Xiao
authors.affiliation: Department of Cardiothoracic Surgery, West China Hospital, Sichuan University, Chengdu, P.R. China.
authors.forename: Eryong
authors.initials: E
authors.lastname: Zhang
authors.affiliation: Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, P. R. China.
authors.forename: Li
authors.initials: L
authors.lastname: Qin
mesh_terms: D000465:Algorithms; D044466:Asian People; D001483:Base Sequence; D002681:China; D004305:Dose-Response Relationship, Drug; D005006:Ethnicity; D005260:Female; D056726:Genetic Association Studies; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D010597:Pharmacogenetics; D015203:Reproducibility of Results; D014859:Warfarin / Q000008:administration & dosage* / Q000627:therapeutic use*
chemical_list: D014859:Warfarin
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