Clinical verification of Lou type warfarin pharmacokinetic dosing algorithms equation

Jiang,Jiangang; Ji,Ningning; Lan,Jingliang; Ge,Xiaoping; Du,Xiaoma

doi:10.3892/mmr.2018.8562

Clinical verification of Lou type warfarin pharmacokinetic dosing algorithms equation

Authors:
- Jiangang Jiang
- Ningning Ji
- Jingliang Lan
- Xiaoping Ge
- Xiaoma Du
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Affiliations: Department of Cardiology, Jinhua Hospital of TCM Affiliated to Zhejiang University of Traditional Chinese Medicine, Jinhua, Zhejiang 321000, P.R. China, Department of Cardiology, Yiwu Central Hospital, Yiwu, Zhejiang 322000, P.R. China, Department of Geriatrics, Zhejiang Jinhua Guangfu Hospital, Jinhua, Zhejiang 321000, P.R. China
Published online on: February 6, 2018 https://doi.org/10.3892/mmr.2018.8562
Pages: 6144-6149

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Abstract

Warfarin is the most commonly used oral anti-coagulant in clinic practice. However, it is difficult to recommend the correct dosage due to its narrow therapeutic window. The aim of the present study was to verify the clinical value of the Lou type equation, using pharmacogenetics‑based warfarin dosing algorithms to appropriately predict the actual maintenance dose. A total of 87 Chinese Han patients who required treatment with warfarin were enrolled and randomly divided into the experimental and control groups. In the experimental group, the first 3 doses of warfarin were calculated according to the Lou type equation. While in the control group, these 3 treatments were performed following the doctors' recommendations. Then the dose of warfarin was gradually adjusted to the stable dose according to the changes in the international standardized ratio. At the end of the 50 day experimental period, there were a greater number of patients in the experimental group who exhibited a stable blood concentration of warfarin than those in the control group (83.35 and 64.4%, respectively). In addition, the mean and median times for patients to obtain a stable dose in the experimental group were significantly shorter than those in the control group (mean, 18.2±1.7 and 27.3±2.0 days; and median, 11.7±1.1 and 20.5±1.8 days, respectively). The adverse reaction rate of the experimental group (9.5%) was markedly lower than that of the control group (26.7%). The occurrence of adverse reactions in the experimental group was also significantly later when compared with the control group (43.9±1.6 and 38.6±1.5 days, respectively). Furthermore, there was no significant difference between the average predicted dose (3.4±1.1 mg/day) and the average actual dose (3.5±1.4 mg/day; P=0.313). In conclusion, using the Lou type warfarin pharmacokinetic dosing algorithm equation to administer warfarin markedly shortened the adjustment time of warfarin to reach a stable dose and reduced the adverse reactions rate, thus supporting clinical feasibility.

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