Kimmel Stephen E
University of Pennsylvania School of Medicine, Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, 717 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021, USA.
Expert Opin Pharmacother. 2008 Apr;9(5):677-86. doi: 10.1517/14656566.9.5.677.
Warfarin therapy has been used clinically for over 60 years, yet continues to be problematic because of its narrow therapeutic index and large inter-individual variability in patient response. As a result, warfarin is a leading cause of serious medication-related adverse events, and its efficacy is also suboptimal.
To review factors that are responsible for variable response to warfarin, including clinical, environmental, and genetic factors, and to explore some possible approaches to improving warfarin therapy.
Recent efforts have focused on developing dosing algorithms that included genetic information to try to improve warfarin dosing. These dosing algorithms hold promise, but have not been fully validated or tested in rigorous clinical trials. Perhaps equally importantly, adherence to warfarin is a major problem that should be addressed with innovative and cost-effective interventions.
Additional research is needed to further test whether interventions can be used to improve warfarin dosing and outcomes.
华法林疗法已在临床上使用超过60年，但由于其治疗指数狭窄且患者反应存在较大个体差异，仍然存在问题。因此，华法林是严重药物相关不良事件的主要原因，其疗效也不尽人意。
回顾导致对华法林反应各异的因素，包括临床、环境和遗传因素，并探索一些改善华法林治疗的可能方法。
最近的努力集中在开发包含遗传信息的给药算法，以试图改善华法林的给药。这些给药算法有前景，但尚未在严格的临床试验中得到充分验证或测试。也许同样重要的是，华法林的依从性是一个主要问题，应通过创新且具成本效益的干预措施加以解决。
需要进一步研究，以进一步测试干预措施是否可用于改善华法林的给药及治疗效果。
