scholarly journals Using Pharmacogenetic Testing to Tailor Warfarin Therapy: The Singapore Experience and What the Future Holds

2020 ◽  
Vol 15 ◽  
Author(s):  
Grace Shu-wen Chang ◽  
Doreen Su-Yin Tan
Keyword(s):  
Clinical Practice ◽  
Genetic Polymorphisms ◽  
Warfarin Therapy ◽  
Asian Population ◽  
Caucasian Population ◽  
Anticoagulation Management ◽  
Healthcare Resources ◽  
Pharmacogenetic Testing ◽  
Select Patient ◽  
Asian Context

Genetic polymorphisms significantly affect individual responses to warfarin, contributing to unpredictability and challenges in managing anticoagulation. Although numerous studies have demonstrated that pharmacogenetic testing improves anticoagulation-related outcomes in the Caucasian population, its effect in the Asian population has not been well studied. This article discusses controversies surrounding tailoring warfarin therapy using pharmacogenetic testing and its role in clinical practice, with a focus on the Asian context. Using the Singapore experience as an example, the authors propose how pharmacogenetic testing can be a means to reduce dose titrations in select patient populations, and how it may be positioned as an enabler to reduce healthcare resources needed for anticoagulation management.

Warfarin-related outcomes in patients with antiphospholipid antibody syndrome managed in an anticoagulation clinic

2006 ◽  
Vol 96 (08) ◽  
pp. 137-141 ◽  
Author(s):  
Jennifer Downing ◽  
Juan Blackburn ◽  
Edith Nutescu ◽  
Ann Wittkowsky
Keyword(s):  
Oral Anticoagulation ◽  
Warfarin Therapy ◽  
Hospital Admissions ◽  
Anticoagulation Clinic ◽  
Bleeding Complications ◽  
Antiphospholipid Antibody ◽  
Antiphospholipid Antibody Syndrome ◽  
Healthcare Resources ◽  
Clinical Endpoints ◽  
Clinic Setting

SummaryPatients with antiphospholipid antibody syndrome (APA) are at elevated risk of venous and arterial thromboembolic complications. Oral anticoagulation with warfarin is recommended for secondary prevention of thromboembolism, but warfarin-related outcomes have not been systematically investigated when warfarin therapy is managed by a dedicated anticoagulation clinic.The objectives of the study were to evaluate warfarin-related monitoring outcomes, clinical endpoints and the use of healthcare resources as a result of warfarin-related complications in patients with APA compared to a group of patients without APA, all of whom were managed in an anticoagulation clinic setting. A retrospective observational cohort design was used to investigate patients with and without APA, all of whom had a history of venous or arterial thromboembolism, and were matched for age, gender and indication for oral anticoagulation. Thirty-six APA patients taking warfarin were compared to a matched cohort of 36 patients without APA. Monitoring outcomes (time in therapeutic range, clinic visits per year, frequency of warfarin dosing adjustments, reasons for out-of-range INRs) were similar between groups, as was the frequency of major bleeding complications (3.2%/pt-yr vs. 3.1%/pt-yr). However, recurrent thromboembolic events (9.6%/pt-yr vs 0) occurred more frequently in APA patients. APA patients required more emergency room visits (6.4%/pt-yr vs. 1.6%/pt-yr) and hospital admissions (14.4%/pt-yr vs.3.0%/pt-yr) to manage complications of warfarin therapy. In conclusion, despite similar monitoring outcomes obtained in a dedicated anticoagulation clinic setting, adverse clinical outcomes are significantly more frequent in patients with APA syndrome than in those without APA, and require more frequent use of healthcare resources.

Comparison of Wrist Motion and Grip Strength in a Normal Chinese and Caucasian Population

2016 ◽  
Vol 21 (03) ◽  
pp. 364-368 ◽  
Author(s):  
Yan Yan Kwok ◽  
Pak-Cheong Ho ◽  
Guy Feldman ◽  
Eugene Lo ◽  
Erik Wells ◽  
...  
Keyword(s):  
Grip Strength ◽  
Mixed Model ◽  
Wrist Joint ◽  
Asian Population ◽  
Caucasian Population ◽  
Relative Contribution ◽  
Therapeutic Procedures ◽  
History Of ◽  
Joint Flexion ◽  
And Gender

Background: Anatomical and functional differences between Asian and Caucasian populations have been described and are important in treatment of wrist pathology. The purpose of this study was to establish and compare normal values in an Asian and Caucasian population. We hypothesized that a normal Asian population will have greater wrist ROM and reduced grip- strength when compared to a normal Caucasian population. Methods: One hundred and–seventy-one normal Asian and 156 normal Caucasian wrists were evaluated. We excluded wrists with current or a history of wrist pathology including past surgery, injury or congenital malformation. We collected demographic information regarding occupation, body mass index (BMI), and previous wrist pathology. The wrist measurements included: wrist extension, flexion, radial, ulnar deviation, and grip strength. Wrists were also evaluated for a mid-carpal clunk, and scaphoid shift test. Mixed models accounted for evaluation of both hands in the same individual and for the relative contribution of different factors to the outcome measures of ROM and grip- strength. Results: The two groups differed in height, BMI and the distribution of occupation. The Asian group had more flexion, less extension and similar radial/ulnar wrist deviation when compared to the Caucasian group. Ethnicity was a significant predictor of wrist joint flexion and extension significantly predicting grip- strength. Age was associated with ROM while occupation, hand side and gender were not significant factors in the mixed model. Conclusions: We found discrete differences between values in the two populations. More study of anatomical morphological patterns may explain the reason for variations in motion and grip- strength. The differences identified in this study between Asian and Caucasian populations should be taken into account when evaluating outcomes of wrist therapeutic procedures and rehabilitation in different communities.

scholarly journals Clinical Practice Recommendations on Genetic Testing of CYP2C9 and VKORC1 Variants in Warfarin Therapy

2015 ◽  
Vol 37 (4) ◽  
pp. 428-436 ◽  
Author(s):  
Kaitlyn Shaw ◽  
Ursula Amstutz ◽  
Richard B. Kim ◽  
Lawrence J. Lesko ◽  
Jacques Turgeon ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Genetic Testing ◽  
Warfarin Therapy ◽  
Practice Recommendations

scholarly journals Telemonitoring in-home complex chronic patients from primary care in routine clinical practice: Impact on healthcare resources use

2017 ◽  
Vol 23 (1) ◽  
pp. 136-143 ◽  
Author(s):  
Iñaki Martín-Lesende ◽  
Estibalitz Orruño ◽  
Maider Mateos ◽  
Elizabete Recalde ◽  
José Asua ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Routine Clinical Practice ◽  
Chronic Patients ◽  
Healthcare Resources

scholarly journals DNMT1 genetic polymorphisms affect breast cancer risk in the central European Caucasian population

2013 ◽  
Vol 5 (1) ◽  
pp. 7 ◽  
Author(s):  
Kathrin Kullmann ◽  
Mustafa Deryal ◽  
Mei Fang Ong ◽  
Werner Schmidt ◽  
Ulrich Mahlknecht
Keyword(s):  
Breast Cancer ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Genetic Polymorphisms ◽  
Caucasian Population ◽  
Central European

scholarly journals Meta-Analysis of ERCC1 Protein Expression and Platinum Chemosensitivity in Non-Small-Cell Lung Cancer

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Guoping Li ◽  
Dan Cheng
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Subgroup Analysis ◽  
Meta Analysis ◽  
Asian Population ◽  
Small Cell ◽  
Caucasian Population ◽  
Small Cell Lung ◽  
Significant Difference

Objective. To carry out the meta-analysis on the relationship between the expression of nucleotide excision repair cross-complementary enzyme 1 (ERCC1) protein and platinum chemosensitivity in patients with advanced non-small-cell lung cancer (NSCLC). Methods. The literature on the expression of ERCC1 and platinum chemosensitivity in patients with advanced NSCLC was searched in computer, which was published from January 2009 to August 2019 on the databases such as China Journal Full-text Database (CJFD), China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP, PubMed, EMBASE, and others. Stata 15.0 was used for statistical analysis, and ethnicity subgroup analysis was taken. Results. Finally, 14 studies were included and 1337 patients were involved, of which 697 were ERCC1 positive, with a positive rate of 53.5%. The combined OR was 0.53 (95% CI: 0.30∼0.79; P<0.01). The results of ethnicity subgroup analysis showed that there was no significant difference, with OR of 0.50 (95% CI: 0.31∼0.82; P=0.001) in Asian population and OR of 0.56 (95% CI: 0.30∼1.07) in Caucasian population. Conclusion. The sensitivity to platinum chemotherapy in patients with ERCC1 protein negative expression in the middle and late stages of NSCLC is better than that in patients with positive expression, especially in Asian population. There is no correlation in Caucasian population.

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