Genotype-Guided Dosing of Warfarin

Genotype-guided dosing of warfarin.

Vitamin K antagonists (VKAs) have been used to treat thromboembolic disease for over 60 years, and they continue to be the most commonly prescribed anticoagulants worldwide. However, VKAs such as warfarin have a narrow therapeutic index, and the mean daily dose of warfarin varies widely from patient to patient. Underdosing can leave patients undertreated for their thromboembolic diseases; overd...

DNA-guided Warfarin Dosing Algorithm Protocol

Clinical Application of Genotype-guided Dosing of Warfarin in Patients with Acute Stroke.

BACKGROUND Patients with certain types of stroke need urgent anticoagulation and it is extremely important for them to achieve fast and stable anticoagulant effect and receive individualized treatment during the initiation of warfarin therapy. METHODS We conducted a prospective study among 210 acute stroke patients who had an indication for anticoagulation and compared the impact of CYP2C9 an...

Cost-effectiveness of genotype-guided warfarin dosing for patients with atrial fibrillation.

BACKGROUND CYP2C9 and VKORC1 genotyping has been advocated as a means of improving the accuracy of warfarin dosing. However, the effectiveness of genotyping in improving anticoagulation control and reducing major bleeding has not yet been compellingly demonstrated. Genotyping currently costs $400 to $550. METHODS AND RESULTS We constructed a Markov model to evaluate whether and under what cir...

Randomized trial of genotype-guided versus standard warfarin dosing in patients initiating oral anticoagulation.

BACKGROUND Pharmacogenetic-guided dosing of warfarin is a promising application of "personalized medicine" but has not been adequately tested in randomized trials. METHODS AND RESULTS Consenting patients (n=206) being initiated on warfarin were randomized to pharmacogenetic-guided or standard dosing. Buccal swab DNA was genotyped for CYP2C9 *2 and CYP2C9 *3 and VKORC1C1173T with a rapid assay...