Pharmacist-guided pharmacogenetic service lowered warfarin-related hospitalizations

Pharmacogenomics. 2023 Apr;24(6):303-314. doi: 10.2217/pgs-2023-0014. Epub 2023 May 11.


Background: The authors aimed to assess outcomes with a pharmacogenetic (PGx)-informed, pharmacist-guided, personalized consult service for warfarin dosing. Methods: This retrospective cohort study included patients admitted with thromboembolic events. Eligible subjects received either PGx-informed (n = 389) or historical non-PGx pharmacist-guided warfarin dosing (Hx; n = 308) before hospital discharge. The composite of admission with bleeding or thromboembolic events over 90 days after the discharge was compared between the PGx and Hx groups. Results: The rate ratio (95% CI) of the composite of bleeding or thromboembolic admissions for PGx versus Hx was 0.32 (0.12-0.82). The estimated hazard ratio was 0.43 (0.16-1.12). Conclusion: A PGx-informed warfarin dosing service was associated with decreased bleeding and thromboembolic encounters.

Keywords: adverse events; anticoagulation; bleeding; pharmacist-guided personalized consult service; pharmacogenetic; thrombosis; warfarin.

MeSH terms

  • Anticoagulants / adverse effects
  • Hemorrhage / chemically induced
  • Hemorrhage / drug therapy
  • Hemorrhage / genetics
  • Hospitalization
  • Humans
  • Pharmacists
  • Pharmacogenetics
  • Retrospective Studies
  • Thromboembolism*
  • Warfarin* / adverse effects


  • Warfarin
  • Anticoagulants