Should we be applying warfarin pharmacogenetics to clinical practice? No, not now.
The U.S. Food and Drug Administration modified warfarin labeling in 2007 to suggest, but not mandate, pharmacogenetic testing. Genetic analysis is now commercially available. However, results predict only one third of all dosing variation, the value of testing in reducing bleeding and thrombosis rates remains unproved, and cost-effectiveness is not established. Careful consideration of clinical factors that influence dosing, conscientious prothrombin time monitoring, and sage dosage adjustment remain paramount in warfarin management. Further study is required before routine warfarin pharmacogenetic testing can be recommended.
Rosove
Michael H
MH
University of California, Los Angeles, Los Angeles, California 90095, USA. mrosove@mednet.ucla.edu
Grody
Wayne W
WW
D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects / Q000378:metabolism; D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics*; D003362:Cost-Benefit Analysis; D065729:Cytochrome P-450 CYP2C9; D006470:Hemorrhage / Q000235:genetics / Q000517:prevention & control; D006801:Humans; D006899:Mixed Function Oxygenases / Q000235:genetics*; D020641:Polymorphism, Single Nucleotide; D011356:Product Labeling; D040081:Protein Array Analysis / Q000191:economics*; D013927:Thrombosis / Q000235:genetics / Q000517:prevention & control; D014481:United States; D014486:United States Food and Drug Administration; D064417:Vitamin K Epoxide Reductases; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects / Q000378:metabolism
D000925:Anticoagulants; D014859:Warfarin; D006899:Mixed Function Oxygenases; C450260:CYP2C9 protein, human; D065729:Cytochrome P-450 CYP2C9; D001189:Aryl Hydrocarbon Hydroxylases; D064417:Vitamin K Epoxide Reductases