Author + information
Vitamin K Antagonist(VKA) is the most commonly used anticoagulant in the treatment and prevention of many thrombotic disorders. The clinical utility of using genetic information to guide VKA dosing remains debated. Our aim was to provide a pooled estimate of potential benefit from randomized controlled trials (RCTs) comparing genotype-based VKA dosing method with prescribing method without pharmocogenetic information.
Relevant RCTs finished before April 2017 were searched through a number of digital databases including MEDLINE, EMBASE and CENTRAL. And then they were pooled by RevMan 5.3 and Comprehensive Meta-Analysis 2.0.
Fourteen RCTs with 3511 patients were included. The pooled results were similar between the two groups at less than or equal to 1 month follow-up. However, compared with standard prescribing method, genotype-based VKA dosing method could significantly improve the time in the therapeutic range [mean difference(MD), 4.59 (95% CI, 0.69-8.50); P= 0.02], significantly shorten the time to stable dose (MD, -7.19 days [95% CI, -7.88 to -6.49]; P< 0.0001) and significantly lower risks of major bleeding (RR: 0.41 [95% CI, 0.21-0.78], P=0.007) at >1 month follow-up. No significant difference was noted in other outcomes.
Genotype-based VKA initiation could improve the quality of oral anticoagulant therapy(OAT) and decrease the risk of major bleeding events in the patients who required more than one month therapy.