ArticlePharmacogenetics and genomics2017
Quality of anticoagulation control and hemorrhage risk among African American and European American warfarin users.
Article in Pharmacogenetics and genomics, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
14 citing papers in PubMed, 2 syntheses or guidelines pooled it, 25 citations in OpenAlex.
- Comparative Safety and Efficacy of Non-vitamin K Antagonist Oral Anticoagulants (NOACs) Versus Warfarin in Deep Vein Thrombosis (DVT) Treatment: A Meta-analysis.Cardiovascular drugs and therapy · 2025Pooled it
- Genetic Factors Influencing Warfarin Dose in Black-African Patients: A Systematic Review and Meta-Analysis.Clinical pharmacology and therapeutics · 2020Pooled it
- Self-testing and clinical outcomes in Black and White patients on warfarin for atrial fibrillation or venous thromboembolism.Research and practice in thrombosis and haemostasis · 2026Observational
- Differences in quality of anticoagulation care delivery according to ethnoracial group in the United States: A scoping review.Journal of thrombosis and thrombolysis · 2024Article
- Polygenic Risk for Type 2 Diabetes in African Americans.Diabetes · 2024Article
- Genomewide Association Study Identifies Copy Number Variants Associated With Warfarin Dose Response and Risk of Venous Thromboembolism in African Americans.Clinical pharmacology and therapeutics · 2023Article
- Development and validation of a trans-ancestry polygenic risk score for type 2 diabetes in diverse populations.Genome medicine · 2022Article
- Translational Pharmacogenomics: Discovery, Evidence Synthesis and Delivery of Race-Conscious Medicine.Clinical pharmacology and therapeutics · 2021Review
- Racial/Ethnic Disparities in Atrial Fibrillation Treatment and Outcomes among Dialysis Patients in the United States.Journal of the American Society of Nephrology : JASN · 2020Article
- Differences in Warfarin Pharmacodynamics and Predictors of Response Among Three Racial Populations.Clinical pharmacokinetics · 2019Article
- Cardiovascular Pharmacogenomics: Does It Matter If You're Black or White?Annual review of pharmacology and toxicology · 2019Review
- Association of Genetic Variants With Warfarin-Associated Bleeding Among Patients of African Descent.JAMA · 2018Article
- Influence of Age on Warfarin Dose, Anticoagulation Control, and Risk of Hemorrhage.Pharmacotherapy · 2018Article
- Evaluation of the Validity of SAMe-TTClinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/HemostasisArticle
Corrections and comments
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Authors and funding
6 authors at 3 institutions in 2 countries.
Funding
Abstract
objectiveWe evaluated whether percent time in target range (PTTR), risk of over-anticoagulation [international normalized ratio (INR)>4], and risk of hemorrhage differ by race. As PTTR is a strong predictor of hemorrhage risk, we also determined the influence of PTTR on the risk of hemorrhage by race. PARTICIPANTS AND
methodsAmong 1326 warfarin users, PTTR was calculated as the percentage of interpolated INR values within the target range of 2.0-3.0. PTTR was also categorized as poor (PTTR<60%), good (60≤PTTR<70%), or excellent (PTTR≥70%) anticoagulation control. Over-anticoagulation was defined as INR more than 4 and major hemorrhages included serious, life-threatening, and fatal bleeding episodes. Logistic regression and survival analyses were carried out to evaluate the association of race with PTTR (≥60 vs. <60) and major hemorrhages, respectively.
resultsCompared with African Americans, European Americans had higher PTTR (57.6 vs. 49.1%; P<0.0001) and were more likely to attain 60≤PTTR<70% (22.9 vs. 13.1%; P<0.001) or PTTR of at least 70% (26.9 vs. 18.2%; P=0.001). Older (>65 years) patients without venous thromboembolism indication and chronic kidney disease were more likely to attain PTTR of at least 60%. After accounting for clinical and genetic factors, and PTTR, African Americans had a higher risk of hemorrhage [hazard ratio (HR)=1.58; 95% confidence interval (CI): 1.04-2.41; P=0.034]. Patients with 60≤PTTR<70% (HR=0.62; 95% CI: 0.38-1.02; P=0.058) and PTTR of at least 70% (HR=0.27; 95% CI: 0.15-0.49; P<0.001) had a lower risk of hemorrhage compared with those with PTTR less than 60%.
conclusionDespite the provision of warfarin management through anticoagulation clinics, African Americans achieve a lower overall PTTR and have a significantly higher risk of hemorrhage. Personalized medicine interventions tailored to African American warfarin users need to be developed.
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