| Objective:By testing the cytochrome P-4502C9(CYP2C9)and vitamin K epoxide reductase complex 1(VKORC1)genetic polymorphisms,using pharmacogenetics to guide the personalized initial anticoagulation of warfarin and analysising the related clinical data.Method:1. Collected 73 pulmonary esbolism patients who using warfarin to anticoagulate in the first time in respiratory department of The First Affiliated Hospital of Kunming University from January 2014 to January 2016.Patients were randomly assigned into the pharmacogenetic-guided group(study group) and non-pharmacogenetic-guided group(control group).The genetic polymorphisms of CYP2C9(-1075A> C) and VKORC1(-1639G>A) of study group were detected by using direct sequencing method. Study group to take predictive dose from CYP2C9 and VKORC1 genotypes and other information,while Control group tp take conventional initial dose.2. Recorded the clinical data including age,gender,weight,height and Body mass index(BMI),monitored international standard radio(INR),adjusted the dose of warfarin according to INR.Recorded the Hospitalization days, the number of INR measurements during the hospitalization days, the number of INR measurements during a month, time in the therapeutic INR range(%TTR) during the hospitalization days and during a month,Time to reach first therapeutic INR(INR>2),The number of INR>3. Recorded the maintenance warfarin dose and predictive dose in study group.3. Analysised the target values by the statistical methed to explore the effects of pharmacogenetic-guided method to the personalized initial anticoagulation of warfarin and analysised the related clinical data.Result:1.①The Hospitalization days of patients in study group were lower than control group(13.53vsl5.94, P<0.001);②The number of INR measurements during the hospitalization days in study group were lower than control group (6.25vs7.08, P< 0.05); ③The number of INR measurements during a month in study group were lower than control group (9.06vs10.16, P<0.05); ④The time in the therapeutic INR range(%TTR) during a month in study group were higher than control group(55%vs49%, P<0.05); ⑤The number of INR>3 during a month in study group were lower than control group (0.92vs1.54, P<0.05).2.1n study group, the maintenance warfarin dose of the different genotypes were coincidence with the predictive dose, and the coincidence rate>80%.Conclusion:1. Testing warfarin genetic polymorphisms combining genetic and clinical factors,taking warfarin pharmacogenetics algorithm to predict warfarin dose,to guide initial anticoagulation therapy can reduce the hospitalization days, the number of INR measurements and the number of INR>3,increase the time in the therapeutic INR range(%TTR).That is to say warfarin pharmacogenetics algorithm can advance the safety,efficacy of anticoagulation,and reduce some economic costs and time spent.2.The predictive dose based on CYP2C9 and VKORC1 genotypes and other information,were coincidence with the maintenance warfarin dose,and the coincidence rate>80%. |
