Related Experiment Video
Updated: Dec 23, 2025
06:04
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
445
Genotype-guided warfarin dosing may benefit patients with mechanical aortic valve replacements: randomized controlled
Kyung Eun Lee1, Jeong Yee2, Gwan Yung Lee2
1College of Pharmacy, Chungbuk National University, 660-1, Yeonje-ri, Osong-eup, Heungdeok-gu, Cheongju-si, 28160, Korea.
Scientific Reports
|April 26, 2020
Summary
Genotype-guided warfarin dosing did not significantly improve time in therapeutic range for Korean patients with mechanical cardiac valves. However, a potential benefit was observed in patients with aortic valve replacement during the initial treatment week.
Area of Science:
- Pharmacogenomics
- Cardiovascular Medicine
- Clinical Pharmacology
Background:
- Warfarin dosing is complex, influenced by genetic factors and patient characteristics.
- Genotype-guided warfarin dosing aims to optimize therapeutic outcomes and minimize adverse events.
- Previous studies suggest genetic variations in VKORC1, CYP2C9, and CYP4F2 impact warfarin metabolism and efficacy.
Purpose of the Study:
- To compare the efficacy of genotype-based warfarin dosing versus standard dosing in Korean patients with mechanical cardiac valves.
- To evaluate the percentage of time in therapeutic range (pTTR) as the primary outcome.
- To assess potential benefits in specific patient subgroups, such as those with aortic valve replacement.
Main Methods:
- Prospective, single-blind, randomized study involving 91 Korean patients with mechanical cardiac valves.
- Patients were stratified into genotype-based dosing (VKORC1, CYP2C9, CYP4F2, age) and standard dosing groups.
- Primary outcomes measured pTTR during the first week, hospitalization, and until the first outpatient visit.
Main Results:
- The genotype-based dosing group showed a trend towards higher pTTR, but the difference was not statistically significant overall.
- No significant differences in genotype frequencies were observed between the two dosing groups.
- Patients with aortic valve replacement in the genotype-based group achieved significantly higher pTTR during the first week compared to the standard group (p < 0.05).
Conclusions:
- Genotype-guided warfarin dosing did not demonstrate a significant overall clinical advantage in this Korean population.
- A potential benefit of genotype-guided dosing may exist for patients with aortic valve replacement, particularly during initial warfarin therapy.
- Further research is warranted to confirm these findings and explore the clinical utility of pharmacogenomic testing for warfarin management.
Related Concept Videos
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
1.9K
Oral anticoagulants are vital tools in preventing and treating blood clotting disorders. This diverse class of medications can be categorized as vitamin K antagonists, exemplified by warfarin, and direct thrombin inhibitors (DTIs), such as dabigatran, as well as factor Xa inhibitors, including rivaroxaban.
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
1.9K
01:25Aortic Regurgitation III: Medical Management
280
Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
280
01:26Mitral Stenosis III: Medical Management
178
Mitral stenosis, a condition marked by the narrowing of the mitral valve, necessitates an integrated approach for effective management. This approach includes preventative measures, medical therapy, and surgical interventions to reduce symptoms and prevent complications.PreventionPrevention of mitral stenosis primarily focuses on reducing the incidence of bacterial infections, particularly streptococcal infections, which can lead to rheumatic fever and subsequent valvular damage. Timely...
178
01:29Venous Thrombosis III: Interprofessional Care
213
Venous thrombosis requires effective prevention and treatment strategies to improve patient outcomes and reduce potential complications.Prevention StrategiesHealthcare providers must prioritize preventing venous thromboembolism (VTE) for all adult patients upon admission. Interventions depend on bleeding and thrombosis risk, medical history, current medications, diagnoses, planned procedures, and patient preferences. Patients on bed rest should change positions every two hours and, if not...
213
01:25Mitral Regurgitation III: Medical Management
197
Mitral regurgitation (MR) is characterized by retrograde blood circulation from the left ventricle into the left atrium due to inadequate mitral valve closure. The severity of the condition, symptoms, and underlying cause determine treatment strategies.Monitoring and Pharmacological TreatmentPatients with mild to moderate MR typically do not need immediate intervention but regular monitoring to assess progression and guide treatment. Patients with mild MR should have an echocardiogram every 3-5...
197
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
1.4K
Hemostasis is a crucial process that prevents excessive blood loss from damaged blood vessels. It involves various mechanisms such as vasoconstriction, platelet adhesion and activation, and fibrin formation. The importance of each mechanism depends on the type of vessel injury. In contrast, thrombosis is the abnormal formation of a blood clot within the blood vessels, leading to potential complications if the clot obstructs blood flow. Thrombosis can be caused by increased coagulability of the...
1.4K