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Pharmacogenetic Dosing of Warfarin

Primary Purpose

Stroke, Venous Thrombosis, Atrial Fibrillation

Status
Completed
Phase
Phase 3
Locations
Taiwan
Study Type
Interventional
Intervention
Standard of care dosing for warfarin
Genotype-guided dosingTaiwan algorithm for warfarin
Genotype-guided dosing IWPC algorithm for warfarin
Sponsored by
Academia Sinica, Taiwan
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Stroke

Eligibility Criteria

20 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Patients must give their informed consent and complete the case report form.
  • Patients must be over the age of 20.
  • Patients have clinical indications for warfarin therapy but do not have any prior warfarin treatment.

Exclusion Criteria:

  • Patients who did not complete the informed consent form or the CRF
  • Patients who are less than the age of 20.
  • Patients who had prior or is currently on warfarin treatment.
  • Patients who have hemorrhagic tendencies or hemorrhagic diseases defined as copious bleeding caused by viral or bacterial infections; cancer and hepatic dysfunction defined as GOP and GPT values three times higher than normal value
  • Patients who has Vitamin K deficiency
  • Female patients who is currently pregnant

Sites / Locations

  • Kaohsiung Medical University
  • China Medical University Hospital
  • Chang Gung Memorial Hospital

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

Active Comparator

Experimental

Experimental

Arm Label

Standard of care dosing for warfarin

Genotype-guided dosingTaiwan algorithm for warfarin

Genotype-guided dosing IWPC algorithm for warfarin

Arm Description

Loading dose (5mg) of warfarin for the first 3 days of treatment. Dose adjustment after initiation will using guideline modified from Tait el al. (1998).

Initial loading dosing of warfarin for the first 3 days of treatment will be determined by the Taiwan algorithm that uses clinical and genetic information. Dose adjustment after initiation will using guideline modified from Tait el al. (1998).

Initial loading dosing of warfarin for the first 3 days of treatment will be determined by the IWPC algorithm that uses clinical and genetic information. Dose adjustment after initiation will using guideline modified from Tait el al. (1998).

Outcomes

Primary Outcome Measures

Time spent in target INR range
time spent in target INR range Time in the target INR Range will be the primary endpoints because of its strong association with adverse events: patients with subtherapeutic INR values are at increased risk of thrombosis and patients with high INR values are at increased risk of hemorrhage during warfarin treatment initiation.

Secondary Outcome Measures

Full Information

First Posted
February 9, 2014
Last Updated
February 16, 2014
Sponsor
Academia Sinica, Taiwan
Collaborators
Chang Gung Memorial Hospital, China Medical University Hospital, Kaohsiung Medical University
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1. Study Identification

Unique Protocol Identification Number
NCT02065388
Brief Title
Pharmacogenetic Dosing of Warfarin
Study Type
Interventional

2. Study Status

Record Verification Date
February 2014
Overall Recruitment Status
Completed
Study Start Date
September 2009 (undefined)
Primary Completion Date
December 2013 (Actual)
Study Completion Date
December 2013 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Academia Sinica, Taiwan
Collaborators
Chang Gung Memorial Hospital, China Medical University Hospital, Kaohsiung Medical University

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
Purpose: Warfarin is now the most commonly used oral anticoagulant. This drug has inter-individual variability due to the genetic polymorphisms in the warfarin metabolizing enzyme, CYP2C9 and warfarin target, VKORC1. The investigators' team developed a pharmacogenetic dosing algorithm which can predict patients required warfarin dose, thus could prevent warfarin induced warfarin adverse events. Methods: The investigators recruited patients with indications for warfarin, the genotypes of VKORC1 and CYP2C9 were determined by the hospitals and verified by National Center for Genome Medicine. The investigators then randomized the patients to one of three arms: 1. Warfarin dose predicted by dosing algorithm developed by the International Warfarin pharmacogenetic Consortium (IWPC), 2. Algorithm developed by the Taiwan Warfarin Consortium and 3. Standard of care. The investigators aimed to determine whether using genetic dosing algorithm can lead to more stable dose and safer use of the drug.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Stroke, Venous Thrombosis, Atrial Fibrillation, Atrial Flutter

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderOutcomes Assessor
Allocation
Randomized
Enrollment
300 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Standard of care dosing for warfarin
Arm Type
Active Comparator
Arm Description
Loading dose (5mg) of warfarin for the first 3 days of treatment. Dose adjustment after initiation will using guideline modified from Tait el al. (1998).
Arm Title
Genotype-guided dosingTaiwan algorithm for warfarin
Arm Type
Experimental
Arm Description
Initial loading dosing of warfarin for the first 3 days of treatment will be determined by the Taiwan algorithm that uses clinical and genetic information. Dose adjustment after initiation will using guideline modified from Tait el al. (1998).
Arm Title
Genotype-guided dosing IWPC algorithm for warfarin
Arm Type
Experimental
Arm Description
Initial loading dosing of warfarin for the first 3 days of treatment will be determined by the IWPC algorithm that uses clinical and genetic information. Dose adjustment after initiation will using guideline modified from Tait el al. (1998).
Intervention Type
Behavioral
Intervention Name(s)
Standard of care dosing for warfarin
Intervention Type
Genetic
Intervention Name(s)
Genotype-guided dosingTaiwan algorithm for warfarin
Intervention Type
Genetic
Intervention Name(s)
Genotype-guided dosing IWPC algorithm for warfarin
Primary Outcome Measure Information:
Title
Time spent in target INR range
Description
time spent in target INR range Time in the target INR Range will be the primary endpoints because of its strong association with adverse events: patients with subtherapeutic INR values are at increased risk of thrombosis and patients with high INR values are at increased risk of hemorrhage during warfarin treatment initiation.
Time Frame
first month of therapy

10. Eligibility

Sex
All
Minimum Age & Unit of Time
20 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Patients must give their informed consent and complete the case report form. Patients must be over the age of 20. Patients have clinical indications for warfarin therapy but do not have any prior warfarin treatment. Exclusion Criteria: Patients who did not complete the informed consent form or the CRF Patients who are less than the age of 20. Patients who had prior or is currently on warfarin treatment. Patients who have hemorrhagic tendencies or hemorrhagic diseases defined as copious bleeding caused by viral or bacterial infections; cancer and hepatic dysfunction defined as GOP and GPT values three times higher than normal value Patients who has Vitamin K deficiency Female patients who is currently pregnant
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Ming Ta Michael Lee, PhD
Organizational Affiliation
Institute of Biomedical Sciences, Academia Sinica
Official's Role
Principal Investigator
Facility Information:
Facility Name
Kaohsiung Medical University
City
Kaohsiung
ZIP/Postal Code
807
Country
Taiwan
Facility Name
China Medical University Hospital
City
Taichung
ZIP/Postal Code
404
Country
Taiwan
Facility Name
Chang Gung Memorial Hospital
City
Taoyuan
ZIP/Postal Code
333
Country
Taiwan

12. IPD Sharing Statement

Citations:
PubMed Identifier
25148255
Citation
Ohara M, Takahashi H, Lee MT, Wen MS, Lee TH, Chuang HP, Luo CH, Arima A, Onozuka A, Nagai R, Shiomi M, Mihara K, Morita T, Chen YT. Determinants of the over-anticoagulation response during warfarin initiation therapy in Asian patients based on population pharmacokinetic-pharmacodynamic analyses. PLoS One. 2014 Aug 22;9(8):e105891. doi: 10.1371/journal.pone.0105891. eCollection 2014.
Results Reference
derived

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Pharmacogenetic Dosing of Warfarin

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