COAG Trial: Dose of warfarin and Pharmacogenetics

Observational studies identified two genes that influence the dose of warfarin (CYP2C9 and VKORC1). The clinical utility of dose adjustment by genetics has been tested only in small studies with conflicting results.

In this multicenter, double-blind randomized 1015 patients comparing strategy initiation of therapy using only clinical information versus using patient’s genotype. The primary endpoint was the percentage of time with a proper RIN (between 2 and 3), the secondary end point was a RIN of >4 or severe clinical event (thromboembolism or bleeding). At 4 weeks of treatment time the percentage of correct range in guided patients by genetics was 45.2 % versus 45.4 % in those clinically guided (p = 0.9 ) . The RIN >4 rate, major bleeding or thromboembolism per year were similar.

Conclusion:

Warfarin dosage adjusted by genetics does not improve coagulation control during the first 4 weeks of treatment.

Editorial

7_stephen_kimmel_articulo
Stephen Kimmel
2013-11-19

Original title: The Clarification of Optimal Anticoagulation through Genetics (COAG) Trial

More articles by this author

ERASE: Endovascular treatment plus exercise versus exercise alone to treat claudication

Initial therapy for intermittent claudication has been historically the gear train, however, especially in recent years; the number of peripheral angioplasties has increased, proving...

RADAR AF: High-frequency ablation versus pulmonary vein isolation to treat atrial fibrillation

Atrial fibrillation is initiated by focal triggers and maintained by an atrial substrate called fractioned complex of atrial electrograms. Isolating the pulmonary veins (triggers)...

EU-PACT: Warfarin dose guided by genotype

Anticoagulation level in response to a fixed dose of warfarin is difficult to predict at the start of therapy. The CYP2C9 gene polymorphism (involved...

ENGAGE AF-TIMI 48: Endoxaban versus warfarin in atrial fibrillation

The endoxaban is an oral direct inhibitor of factor Xa with a rapid onset of action and a half-life of 8-10 hours. Endoxaban efficacy...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

Severe Tricuspid Regurgitation: Surgical vs. Transcatheter Edge-to-Edge Repair

While highly prevalent, tricuspid regurgitation is a notably undertreated valvulopathy. Its progression has been associated with higher mortality and significant disability. According to the...

ACCESS-TAVI: Comparing Post TAVR Vascular Closure Devices

Transcatheter aortic valve replacement (TAVR) is a well-established option to treat elderly patients with severe symptomatic aortic valve stenosis. Technical advances and device development...

Endovascular Treatment of Iliofemoral Disease for the Improvement of Heart Failure with Preserved Ejection Fraction

Peripheral artery disease (PAD) is a significant risk factor in the development of difficult-to-treat conditions, such as heart failure with preserved ejection fraction (HFpEF)....