초록접수 현황
| 17F-131 | 포스터 발표 |
The Initial Warfarin dose after Valve Replacement was Larger than Estimated dose by Pharmacogenetic-guided Algorithms
So Young Lee, Seok In Lee, Chang Hyu Choi, Chul Hyun Park, Kook Yang Park, Jae-Ik Lee, Kun Woo Kim, Kuk Hui Son
Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
Purpose : Recently, it has been recommended that initial warfarin dose determined from pharmacogenetic-guided algorithms, because warfarin has very narrow therapeutic range. The mostly commonly used algorism is the one from ‘WarfarinDosing.org’ which is supported by the Barnes-Jewish Hospital at Washington University Medical Center, the NIH, and donations. The warfarin dose estimates are based on clinical factors such as age, ethnicity, race, weight, height, smoking, presence of liver disease, indication for warfarin treatment, baseline INR, target INR, medications which effect on cytochrome function, and genotypes of two genes: cytochrome P450 2C9 (CYP2C9) and vitamin K epoxide reductase (VKORC1). We compared the actual initial dose and estimated dose determined from pharmacogenetic-guided algorithms.
Methods : 35 Korean patients (58.65±9.01 years old) who underwent valve replacement surgery from 2003 to 2015 in our hospital were enrolled this study. We analyzed the CYP2C9*2 (rs1799853), CYP2C9*3 (rs1057910), and VKORC1 (rs9923231). We defined underestimated dose (patients whose estimated dose was > 20% below the actual dose), ideal dose (patients whose estimates dose was within 20% of the actual dose), and overestimated dose (patients whose estimated dose was >20% above the actual dose).
Results : The weight and height was 63.77±10.89 kg and 164.31±10.75 ㎝, respectively. All patients had wild type of CYP2C9*2. There was 1 of heterozygote (AC) of CYP2C9*3, and 34 of wild type (AA) of CYP2C9*3. There were 31 of AA type of VKORC1 which is known as warfarin sensitive type, and 4 of AG type which showed normal warfarin metabolism. The initial INR level before warfarin start were 1.21±0.13. The actual initial dose range was 3-6 mg, however the estimated dose rage was 2-4 mg. 32 patient got overestimated dose, and only 3 patient got ideal dose.
Conclusion : There was tendency that the actual initial warfarin dose was higher than estimated dose determined from pharmacogenetic-guided algorithms.
Methods : 35 Korean patients (58.65±9.01 years old) who underwent valve replacement surgery from 2003 to 2015 in our hospital were enrolled this study. We analyzed the CYP2C9*2 (rs1799853), CYP2C9*3 (rs1057910), and VKORC1 (rs9923231). We defined underestimated dose (patients whose estimated dose was > 20% below the actual dose), ideal dose (patients whose estimates dose was within 20% of the actual dose), and overestimated dose (patients whose estimated dose was >20% above the actual dose).
Results : The weight and height was 63.77±10.89 kg and 164.31±10.75 ㎝, respectively. All patients had wild type of CYP2C9*2. There was 1 of heterozygote (AC) of CYP2C9*3, and 34 of wild type (AA) of CYP2C9*3. There were 31 of AA type of VKORC1 which is known as warfarin sensitive type, and 4 of AG type which showed normal warfarin metabolism. The initial INR level before warfarin start were 1.21±0.13. The actual initial dose range was 3-6 mg, however the estimated dose rage was 2-4 mg. 32 patient got overestimated dose, and only 3 patient got ideal dose.
Conclusion : There was tendency that the actual initial warfarin dose was higher than estimated dose determined from pharmacogenetic-guided algorithms.
책임저자: Kuk Hui Son
Department of Thoracic and Cardiovascular Surgery, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
발표자: Kuk Hui Son, E-mail : dr632@gilhospital.com