TY - JOUR
T1 - Genotype-guided versus standard vitamin K antagonist dosing algorithms in patients initiating anticoagulation
AU - Belley-Cote, Emilie P.
AU - Hanif, Hasib
AU - D'Aragon, Frederick
AU - Eikelboom, John W.
AU - Anderson, Jeffrey L.
AU - Borgman, Mark
AU - Jonas, Daniel E.
AU - Kimmel, Stephen E.
AU - Manolopoulos, Vangelis G.
AU - Baranova, Ekaterina
AU - Maitland-van der Zee, Anke H.
AU - Pirmohamed, Munir
AU - Whitlock, Richard P.
PY - 2015
Y1 - 2015
N2 - Variability in vitamin K antagonist (VKA) dosing is partially explained by genetic polymorphisms. We performed a meta-analysis to determine whether genotype-guided VKA dosing algorithms decrease a composite of death, thromboembolic events and major bleeding (primary outcome) and improve time in therapeutic range (TTR). We searched MEDLINE, EMBASE, CENTRAL, trial registries and conference proceedings for randomised trials comparing genotype-guided and standard (non genotype-guided) VKA dosing algorithms in adults initiating anticoagulation. Data were pooled using a random effects model. Of the 12 included studies (3,217 patients), six reported all components of the primary outcome of mortality, thromboembolic events and major bleeding (2,223 patients, 87 events). Our meta-analysis found no significant difference between groups for the primary outcome (relative risk 0.85, 95% confidence interval {Cl] 0.54-1.34; heterogeneity X-2=4.46, p=0.35, I-2=10%). Based on 10 studies (2,767 patients), TTR was significantly higher in the genotype-guided group (mean difference (MD) 4.31%; 95% Cl 0.35, 8.26; heterogeneity X-2=43.31, p <0.001, I-2=79%). Pre-specified exploratory analyses demonstrated that TTR was significantly higher when genotype-guided dosing was compared with fixed VKA dosing (6 trials, 997 patients: MD 8.41 %; 95% Cl 3.50,13.31; heterogeneity X-2=15.18, p=0.01, I-2=67%) but not when compared with clinical algorithm-guided dosing (4 trials, 1,770 patients: MD 0.29%; 95% Cl -2.48,1.90; heterogeneity X-2=1.53, p=0.68, I-2=0%; p for interaction=0.002). In conclusion, genotype-guided compared with standard VKA dosing algorithms were not found to decrease a composite of death, thromboembolism and major bleeding, but did result in improved TTR. An improvement in TTR was observed in comparison with fixed VKA dosing algorithms, but not with clinical algorithms
AB - Variability in vitamin K antagonist (VKA) dosing is partially explained by genetic polymorphisms. We performed a meta-analysis to determine whether genotype-guided VKA dosing algorithms decrease a composite of death, thromboembolic events and major bleeding (primary outcome) and improve time in therapeutic range (TTR). We searched MEDLINE, EMBASE, CENTRAL, trial registries and conference proceedings for randomised trials comparing genotype-guided and standard (non genotype-guided) VKA dosing algorithms in adults initiating anticoagulation. Data were pooled using a random effects model. Of the 12 included studies (3,217 patients), six reported all components of the primary outcome of mortality, thromboembolic events and major bleeding (2,223 patients, 87 events). Our meta-analysis found no significant difference between groups for the primary outcome (relative risk 0.85, 95% confidence interval {Cl] 0.54-1.34; heterogeneity X-2=4.46, p=0.35, I-2=10%). Based on 10 studies (2,767 patients), TTR was significantly higher in the genotype-guided group (mean difference (MD) 4.31%; 95% Cl 0.35, 8.26; heterogeneity X-2=43.31, p <0.001, I-2=79%). Pre-specified exploratory analyses demonstrated that TTR was significantly higher when genotype-guided dosing was compared with fixed VKA dosing (6 trials, 997 patients: MD 8.41 %; 95% Cl 3.50,13.31; heterogeneity X-2=15.18, p=0.01, I-2=67%) but not when compared with clinical algorithm-guided dosing (4 trials, 1,770 patients: MD 0.29%; 95% Cl -2.48,1.90; heterogeneity X-2=1.53, p=0.68, I-2=0%; p for interaction=0.002). In conclusion, genotype-guided compared with standard VKA dosing algorithms were not found to decrease a composite of death, thromboembolism and major bleeding, but did result in improved TTR. An improvement in TTR was observed in comparison with fixed VKA dosing algorithms, but not with clinical algorithms
U2 - https://doi.org/10.1160/TH15-01-0071
DO - https://doi.org/10.1160/TH15-01-0071
M3 - Review article
C2 - 26158747
SN - 0340-6245
VL - 114
SP - 768
EP - 777
JO - Thrombosis and haemostasis
JF - Thrombosis and haemostasis
IS - 4
ER -