Implementing Algorithm-Guided Warfarin Dosing in an Ethnically Diverse Patient Population Using Electronic Health Records and Preemptive CYP2C9 and VKORC1 Genetic Testing

Clin Pharmacol Ther. 2016 Nov;100(5):427-430. doi: 10.1002/cpt.425. Epub 2016 Aug 18.

Abstract

Implementation of pharmacogenetic-guided warfarin dosing has been hindered by inconsistent results from reported clinical trials and a lack of available algorithms that include alleles prevalent in non-white populations. However, current evidence indicates that algorithm-guided dosing is more accurate than empirical dosing. To facilitate multiethnic algorithm-guided warfarin dosing using preemptive genetic testing, we developed a strategy that accounts for the complexity of race and leverages electronic health records for algorithm variables and deploying point-of-care dose recommendations.

MeSH terms

  • Algorithms*
  • Anticoagulants / administration & dosage
  • Cytochrome P-450 CYP2C9 / genetics*
  • Dose-Response Relationship, Drug
  • Drug Dosage Calculations
  • Electronic Health Records*
  • Ethnic Groups
  • Genetic Testing*
  • Humans
  • Pharmacogenetics / methods
  • Polymorphism, Genetic
  • Vitamin K Epoxide Reductases / genetics*
  • Warfarin / administration & dosage*

Substances

  • Anticoagulants
  • Warfarin
  • Cytochrome P-450 CYP2C9
  • VKORC1 protein, human
  • Vitamin K Epoxide Reductases