Efficacy and safety of genotype-guided warfarin in preventing and treating thromboembolic disease：a systematic review

Abstract:

Objective：To evaluate the efficacy and safety of genotype-guided warfarin in preventing and treating thromboembolic dis－ease using Meta-analysis. Methods：PubMed database，Cochrane Library，Wanfang，VIP and CNKI were systemically searched for lit－erature of genotype-guided warfarin in preventing and treating thromboembolic disease. The searching date was up to January 1，2014. The data extraction and methodological grading were performed independently by two authors. RevMan version 5.2 was used for sta－tistical analysis. Results：A total of 11 randomized controlled trials（RCTs） were included in systematic review and 10 RCTs（2 905 cases） were quantitatively analyzed. The results of Meta-analysis showed that there was no significant difference between genotypic warfarin-dosing group and control dosing group in the aspects of percentage of time in the international normalized ratio therapeutic range（SMD=0.11，95%CI＝-0.06 to 0.29，P=0.21），patients with stable dose（RR=1.13；95%CI＝1.00 to 1.28，P=0.05），over coagulation（RR=0.95，95%CI＝0.83 to 1.08，P=0.44），bleeding（RR=0.89，95%CI＝0.78 to 1.01，P=0.08），thromboembolism（RR=0.61，95%CI＝0.30 to 1.23，P=0.17）. There was no significant difference between genotypic warfarin-dosing group and control dosing group in per－centage of time in the INR therapeutic range and patients with stable dose. The sensitivity analysis of outcomes showed that the re－sults were stable and reliable. Conclusion：The evidence of superiority in efficacy and safety of genotype-guided warfarin in prevent－ing and treating thromboembolic disease is still insufficient.