A Randomized Trial of Genotype-Guided Dosing of Acenocoumarol and Phenprocoumon

A Randomized Trial of Genotype-Guided Dosing of Acenocoumarol and Phenprocoumon

A genotype-guided dosing algorithm was compared with a clinical dosing algorithm in patients starting anticoagulation with acenocoumarol or phenprocoumon. There was no difference between the two groups in the percentage of time in the therapeutic INR range of 2.0 to 3.0. Coumarin anticoagulant agent...

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Bibliographic Details
Published in:The New England journal of medicine Vol. 369; no. 24; pp. 2304 - 2312
Main Authors: Verhoef, Talitha I, Ragia, Georgia, de Boer, Anthonius, Barallon, Rita, Kolovou, Genovefa, Kolovou, Vana, Konstantinides, Stavros, Le Cessie, Saskia, Maltezos, Efstratios, van der Meer, Felix J.M, Redekop, William K, Remkes, Mary, Rosendaal, Frits R, van Schie, Rianne M.F, Tavridou, Anna, Tziakas, Dimitrios, Wadelius, Mia, Manolopoulos, Vangelis G, Maitland-van der Zee, Anke H
Format: Journal Article
Language:English
Published: Waltham, MA Massachusetts Medical Society 12-12-2013
Subjects:
Acenocoumarol - administration & dosage
Aged
Algorithms
Anticoagulants
Anticoagulants - administration & dosage
Aryl Hydrocarbon Hydroxylases - genetics
Biological and medical sciences
Blood. Blood coagulation. Reticuloendothelial system
Clinical trials
Cytochrome P-450 CYP2C9
Drug dosages
Enzymes
Evidence-based medicine
Female
Fibrillation
Follow-Up Studies
General aspects
Genotype
Genotypes
Genotyping
Humans
International Normalized Ratio
Male
Medical sciences
Medical treatment
Middle Aged
Patients
Pharmacogenetics
Pharmacology. Drug treatments
Phenprocoumon - administration & dosage
Single-Blind Method
Thromboembolism
Thromboembolism - chemically induced
Treatment Failure
Vitamin K Epoxide Reductases - genetics
Greece
Netherlands
Medicine
Antivitamin K
Microbiological investigation
Typing
Coumarine derivatives
Genotype
Anticoagulant
Phenprocoumon
Acenocoumarol
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Summary:A genotype-guided dosing algorithm was compared with a clinical dosing algorithm in patients starting anticoagulation with acenocoumarol or phenprocoumon. There was no difference between the two groups in the percentage of time in the therapeutic INR range of 2.0 to 3.0. Coumarin anticoagulant agents such as acenocoumarol, phenprocoumon, and warfarin are frequently used for the prevention of stroke in patients with atrial fibrillation or for the treatment and prevention of venous thromboembolism. 1 In many countries, warfarin is used most frequently, but in some countries, acenocoumarol or phenprocoumon is prescribed. 2 Coumarin anticoagulant drugs have a narrow therapeutic window, and there are large interpatient and intrapatient variations in the dose requirement. The anticoagulant effect of these drugs is monitored by means of regular measurement of the international normalized ratio (INR). 3 A subtherapeutic INR is associated with an increased risk of stroke or thromboembolism, . . .
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ISSN:0028-4793
1533-4406
1533-4406
DOI:10.1056/NEJMoa1311388