The Clinical Efficacy Of Genotype-guided Warfarin Dosing:A Meta-analysis

Objective:There have been many studies on the efficacy and safety of warfarin genotype in guiding clinical medication,but the conclusions are not consistent.Now a meta-analysis is conducted on randomized trials to systematically evaluate the efficacy and safety of warfarin genotype in guiding clinical medication.Methods:The database was retrieved to the randomised controlled trials of Pubmed,Embase,Cochrane library,wanfang database and cnki in October 2018.Meanwhile,the included randomised controlled trials were meta-analyzed using Revman5.3 software.At the same time,subgroup analysis was conducted according to the follow-up time to explore whether there were differences in clinical endpoints,and to evaluate the efficacy and safety of warfarin genotype in guiding clinical medication.Draw funnel plot to evaluate publication bias.Results: A total of 1,494 literatures were retrieved,and a total of 11 studies including 4475 patients were included in the final meta-analysis.Subgroup analysis was performed for TTR,INR>4,major bleeding events according to different follow-up time.Subgroup analysis at 1 month follow-up showed no difference in TTR between GD group and CD group(WMD=1.30%,95%CI:-0.27-2.87,P=0.11),no difference in INR>4 events(RR=0.88,95%CI: 0.6-1.3,P=0.52),and significant reduction in major bleeding events(RR=0.41,95%CI: 0.18-0.94,P=0.03).Among the subgroups with a follow-up time of more than 1 month,TTR in GD group was significantly better than that in CD group(WMD=5.37%,95%CI: 3.24-7.50,P< 0.00001),INR>4 events showed no difference(RR=1.01,95%CI: 0.83-1.23,P=0.93),and major bleeding events was significantly reduced(RR=0.5,95%CI: 0.28-0.9,P=0.02).There was no difference inembolic events between the GD group and the CD group(RR=0.73,95% CI: 0.48-1.1,P=0.14).Conclusions: Warfarin genotype-guided therapy significantly reduced major bleeding events within 1 month.However,there was no difference in TTR and INR>4 events between the GD group and the CD group.After 1 month,TTR significantly increased and the incidence of major bleeding events significantly decreased.There was no difference in the incidence of thromboembolic events and INR>4 events between the GD group and the CD group.Warfarin genotype has shown its superiority in guiding clinical medication for patients with long-term anticoagulation and high blood risk.