title: Comparison of the Performance of the Warfarin Pharmacogenetics Algorithms in Patients with Surgery of Heart Valve Replacement and Heart Valvuloplasty.
abstract: A large number of warfarin pharmacogenetics algorithms have been published. Our research was aimed to evaluate the performance of the selected pharmacogenetic algorithms in patients with surgery of heart valve replacement and heart valvuloplasty during the phase of initial and stable anticoagulation treatment. 10 pharmacogenetic algorithms were selected by searching PubMed. We compared the performance of the selected algorithms in a cohort of 193 patients during the phase of initial and stable anticoagulation therapy. Predicted dose was compared to therapeutic dose by using a predicted dose percentage that falls within 20% threshold of the actual dose (percentage within 20%) and mean absolute error (MAE). The average warfarin dose for patients was 3.05±1.23mg/day for initial treatment and 3.45±1.18mg/day for stable treatment. The percentages of the predicted dose within 20% of the therapeutic dose were 44.0±8.8% and 44.6±9.7% for the initial and stable phases, respectively. The MAEs of the selected algorithms were 0.85±0.18mg/day and 0.93±0.19mg/day, respectively. All algorithms had better performance in the ideal group than in the low dose and high dose groups. The only exception is the Wadelius et al. algorithm, which had better performance in the high dose group. The algorithms had similar performance except for the Wadelius et al. and Miao et al. algorithms, which had poor accuracy in our study cohort. The Gage et al. algorithm had better performance in both phases of initial and stable treatment. Algorithms had relatively higher accuracy in the >50years group of patients on the stable phase.
authors.affiliation: Department of Pharmacy, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
authors.forename: Hang
authors.initials: H
authors.lastname: Xu
authors.affiliation: Department of Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China.
authors.forename: Shi
authors.initials: S
authors.lastname: Su
authors.affiliation: Department of Clinical Pharmacy, China Pharmaceutical University, Nanjing, Jiangsu, China.
authors.forename: Wuji
authors.initials: W
authors.lastname: Tang
authors.affiliation: Department of Pharmacy, Affiliated Jinling Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
authors.forename: Meng
authors.initials: M
authors.lastname: Wei
authors.affiliation: Department of Cardiothoracic Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Wang
authors.affiliation: Department of Cardiothoracic Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China. Electronic address: gldjw@163.com.
authors.forename: Dongjin
authors.initials: D
authors.lastname: Wang
authors.affiliation: Department of Pharmacy, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China. Electronic address: 6221230@sina.com.
authors.forename: Weihong
authors.initials: W
authors.lastname: Ge
mesh_terms: D000465:Algorithms; D000925:Anticoagulants / Q000008:administration & dosage; D058385:Cardiac Valve Annuloplasty / Q000009:adverse effects*; D020000:Decision Support Systems, Clinical; D004305:Dose-Response Relationship, Drug; D004360:Drug Therapy, Computer-Assisted; D004361:Drug Tolerance / Q000235:genetics; D005260:Female; D020022:Genetic Predisposition to Disease / Q000235:genetics; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010597:Pharmacogenetics / Q000379:methods; D013927:Thrombosis / Q000209:etiology / Q000235:genetics* / Q000517:prevention & control*; D016896:Treatment Outcome; D014859:Warfarin / Q000008:administration & dosage*
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: Dosing algorithm; Performance; Pharmacogenetics; Warfarin