Clinical versus fixed warfarin dosing and the impact on quality of anticoagulation (The ClinFix trial).

Autor: Fahmi AM; Pharmacy Department, Hamad Medical Corporation, Doha, Qatar., El Bardissy A; Pharmacy Department, Hamad Medical Corporation, Doha, Qatar., Saad MO; Pharmacy Department, Hamad Medical Corporation, Doha, Qatar., Elshafei MN; Pharmacy Department, Hamad Medical Corporation, Doha, Qatar., Bader L; College of Pharmacy, Qatar University, Doha, Qatar., Mahfouz A; Pharmacy Department, Hamad Medical Corporation, Doha, Qatar., Kasem M; Pharmacy Department, Hamad Medical Corporation, Doha, Qatar., Abdelsamad O; Pharmacy Department, Hamad Medical Corporation, Doha, Qatar., Elzouki A; Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar., Aquilante CL; Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, USA., Mraiche F; Department of Pharmacology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada., Soaly E; Department of Cardiology, AlWakra Hospital, Hamad Medical Corporation, AlWakra, Qatar., El Madhoun I; Department of Medicine, AlWakra Hospital, Hamad Medical Corporation, AlWakra, Qatar., Asaad N; Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar., Arabi A; Department of Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar., Alhmoud E; Pharmacy Department, Hamad Medical Corporation, Doha, Qatar., Elewa H; College of Pharmacy, Qatar University, Doha, Qatar.
Jazyk: angličtina
Zdroj: Clinical and translational science [Clin Transl Sci] 2024 Jun; Vol. 17 (6), pp. e13797.
DOI: 10.1111/cts.13797
Abstrakt: Different dosing strategies exist to initiate warfarin, most commonly fixed warfarin dosing (FWD), clinical warfarin dosing (CWD), and genetic-guided warfarin dosing (GWD). Landmark trials have shown GWD to be superior when compared to FWD in the EU-PACT trial or CWD in the GIFT trial. COAG trial did not show differences between GWD and CWD. We aim to compare the anticoagulation quality outcomes of CWD and FWD. This is a prospective cohort study with a retrospective comparator. Recruited subjects in the CWD (prospective) arm were initiated on warfarin according to the clinical dosing component of the algorithm published in www.warfarindosing.org. The primary efficacy outcome was the percentage time in the therapeutic range (PTTR) from day 3 to 6 till day 28 to 35. The study enrolled 122 and 123 patients in the CWD and FWD, respectively. The PTTR did not differ statistically between CWD and FWD (62.2 ± 26.2% vs. 58 ± 25.4%, p = 0.2). There was also no difference between both arms in the percentage of visits with extreme subtherapeutic international normalized ratio (INR) (<1.5; 15 ± 18.3% vs. 16.8 ± 19.1%, p = 0.44) or extreme supratherapeutic INR (>4; 7.7 ± 14.7% vs. 7.5 ± 12.4%, p = 0.92). We conclude that CWD did not improve the anticoagulation quality parameters compared to the FWD method.
(© 2024 Qatar University. Clinical and Translational Science published by Wiley Periodicals LLC on behalf of American Society for Clinical Pharmacology and Therapeutics.)
Databáze: MEDLINE
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