GENETIC ASPECTS OF WARFARIN DOSING ALGORITHMS IN CARDIAC SURGERY PATIENTS WHO HAVE UNDERGONE HEART SURGERY: SYSTEMATIC REVIEW.

Abstract

Objective: To evaluate the clinical outcome, safety, and application of personalized therapy using pharmacogenetic warfarin dosing algorithms in cardiac surgery patients systemically.

Methods: This systematic review focused on 17 published studies between January 2015 to March 2025 regarding warfarin dosing algorithms incorporating CYP2C9 and VKORC1 polymorphisms in patients who underwent cardiac surgery. The primary outcomes were TTR, BER, and INR stability. The databases search was performed on Scopus, Web of Science, PubMed, and Cochrane.

Results: This systematic review highlights the effectiveness of genotype-stratified warfarin dosing after cardiac surgery. Bayesian models showed an improvement in TTR, with NextDose achieving 63% versus 56% with standard dosing. Genotype-guided approaches reduced bleeding events from 34 to 16 and increased INR stability from 83.1% to 86.1%, improving dosing precision and achieving a TTR of 77.76% compared to 57.43%.

Conclusion: These findings reinforce the clinical importance of the use of genotype data for more precise warfarin dosing in improving TTR, INR control, and bleeding risk. Further studies are needed to optimize the algorithms, extend the gene panels, and tailor the approaches more for patients after cardiac surgery.