Prospective dosing of warfarin based on cytochrome P-450 2C9 genotype.

Journal Article (Journal Article)

Cytochrome P-450 2C9 (CYP2C9) polymorphisms (CYP2C9*2 and CYP2C9*3) reduce the clearance of warfarin, increase the risk of bleeding, and prolong the time to stable dosing. Whether prospective use of a retrospectively developed algorithm that incorporates CYP2C9 genotype and nongenetic factors can ameliorate the propensity to bleeding and delay in achieving a stable warfarin dose is unknown. We initiated warfarin therapy in 48 orthopedic patients tailored to the following variables: CYP2C9 genotype, age, weight, height, gender, race, and use of simvastatin or amiodarone. By using pharmacogenetics-based dosing, patients with a CYP2C9 variant achieved a stable, therapeutic warfarin dose without excessive delay. However compared to those without a CYP2C9 variant, patients with a variant continued to be at increased risk (hazard ratio 3.6, 95% confidence interval 1.4-9.5, p = 0.01) for an adverse outcome (principally INR > 4), despite pharmacogenetics-based dosing. There was a linear relationship (R(2) = 0.42, p < 0.001) between the pharmacogenetics-predicted warfarin doses and the warfarin maintenance doses, prospectively validating the dosing algorithm. Prospective, perioperative pharmacogenetics-based dosing of warfarin is feasible; however, further evaluation in a randomized, controlled study is recommended.

Full Text

Duke Authors

Cited Authors

  • Voora, D; Eby, C; Linder, MW; Milligan, PE; Bukaveckas, BL; McLeod, HL; Maloney, W; Clohisy, J; Burnett, RS; Grosso, L; Gatchel, SK; Gage, BF

Published Date

  • April 2005

Published In

Volume / Issue

  • 93 / 4

Start / End Page

  • 700 - 705

PubMed ID

  • 15841315

International Standard Serial Number (ISSN)

  • 0340-6245

Digital Object Identifier (DOI)

  • 10.1160/TH04-08-0542


  • eng

Conference Location

  • Germany