Acenocoumarol Pharmacogenetic Dosing Algorithm versus Usual Care in Patients with Venous Thromboembolism: A Randomised Clinical Trial

• Published in: Journal of clinical medicine Vol. 10; no. 13; p. 2949
• Main Authors: Tong, Hoi, Borobia, Alberto, Quintana-Díaz, Manuel, Fabra, Sara, González-Viñolis, Manuel, Fernández-Capitán, Carmen, Rodriguez-Dávila, María, Lorenzo, Alicia, López-Parra, Ana, Ruiz-Giménez, Nuria, Abad-Santos, Francisco, Suarez, Carmen, Madridano, Olga, Gómez-Cerezo, Jorge, Llamas, Pilar, Baeza-Richer, Carlos, Arroyo-Pardo, Eduardo, Carcas, Antonio
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 30-06-2021; MDPI
• Subjects: Algorithms; Anticoagulants; Cardiac arrhythmia; Clinical medicine; Clinical trials; Design; Drug dosages; Genotype & phenotype; Legal medicine; Medicine; Patients; Thromboembolism; Thrombosis; Spain
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm10132949

Patients with venous thromboembolism (VTE) require immediate treatment with anticoagulants such as acenocoumarol. This multicentre randomised clinical trial evaluated the effectiveness of a dosing pharmacogenetic algorithm versus a standard-of-care dose adjustment at the beginning of acenocoumarol treatment. We included 144 patients with VTE. On the day of recruitment, a blood sample was obtained for genotyping (CYP2C9*2, CYP2C9*3, VKORC1, CYP4F2, APOE). Dose adjustment was performed on day 3 or 4 after the start of treatment according to the assigned group and the follow-up was at 12 weeks. The principal variable was the percentage of patients with an international normalised ratio (INR) within the therapeutic range on day 7. Thirty-four (47.2%) patients had an INR within the therapeutic range at day 7 after the start of treatment in the genotype-guided group compared with 14 (21.9%) in the control group (p = 0.0023). There were no significant differences in the time to achieve a stable INR, the number of INRs within the range in the first 6 weeks and at the end of study. Our results suggest the use of a pharmacogenetic algorithm for patients with VTE could be useful in achieving target INR control in the first days of treatment.