MedicalResearch.com Interview with:
Anne R. Bass, MD
Associate Professor of Clinical Medicine
Weill Cornell Medical College
Rheumatology Fellowship Program Director
Hospital for Special Surgery
New York, NY 10021
MedicalResearch.com: What is the background for this study?
Response: Blood thinners are used after orthopedic surgery to prevent blood clots from forming in the legs and traveling to the lungs. They are also used in patients with certain heart diseases to prevent strokes. Blood thinners, like warfarin, are effective but can be associated with serious bleeding complications, especially if the wrong dose is given. Genetic testing can help doctors predict the right warfarin dose to use in an individual patient.
In this trial, ≈1600 elderly patients undergoing hip or knee replacement were randomly assigned to receive warfarin dosing based on genetics plus clinical factors (like height, weight and gender), or based on clinical factors alone. The specific genes tested wereVKORC1, CYP2C9, and CYP4F2 which influence warfarin metabolism and the body’s ability to produce clotting factors.
MedicalResearch.com: What are the main findings?
Response: The study showed that the use of genetic testing reduces the risk of complications including major bleeding, blood clotting and warfarin overdose. These adverse events occurred in 14.7% of the clinically-guided group, but only 10.8% of the genetics-guided group, a 27% reduction.
MedicalResearch.com: What should readers take away from your report?
Response: This study showed that the use of genetic testing to personalize warfarin dosing makes treatment safer for our patients.
There is been an explosion of genetic knowledge over the last decade –the challenge is to apply that knowledge to the care of patients which is what we did in this study.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Similar studies of warfarin genetics are needed in populations with different racial and ethnic backgrounds. It will also be important to study outcomes when genetic-based warfarin dosing is used in a “real world” setting, rather than a clinical trial.
Disclosures: The trial was funded by NIH’s National Heart, Lung, and Blood Institute (NHLBI).
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Citation: Gage BF, Bass AR, Lin H, Woller SC, Stevens SM, Al-Hammadi N, Li J, Rodríguez T, Miller JP, McMillin GA, Pendleton RC, Jaffer AK, King CR, Whipple BD, Porche-Sorbet R, Napoli L, Merritt K, Thompson AM, Hyun G, Anderson JL, Hollomon W, Barrack RL, Nunley RM, Moskowitz G, Dávila-Román V, Eby CS. Effect of Genotype-Guided Warfarin Dosing on Clinical Events and Anticoagulation Control Among Patients Undergoing Hip or Knee ArthroplastyThe GIFT Randomized Clinical Trial. JAMA. 2017;318(12):1115–1124. doi:10.1001/jama.2017.11469
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