title: Feasibility of implementing a comprehensive warfarin pharmacogenetics service.
abstract: OBJECTIVE
  To determine the procedural feasibility of a pharmacist-led interdisciplinary service for providing genotype-guided warfarin dosing for hospitalized patients newly starting warfarin.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  A 438-bed tertiary care hospital affiliated with a large academic institution.
  
  
  METHODS
  Eighty patients who started warfarin therapy and were managed by a newly implemented pharmacogenetics service.
  
  
  METHODS
  All patients received routine warfarin genotyping and clinical pharmacogenetics consultation.
  
  
  RESULTS
  The primary outcomes were percentage of genotype-guided dose recommendations available prior to the second warfarin dose and adherence of the medical staff to doses recommended by the pharmacogenetics service. Of 436 genotype orders placed during the first 6 months of the service, 190 (44%) were deemed appropriate. For the 80 patients on the service who consented to data collection, 76% of the genotypes were available prior to the second warfarin dose. The median (range) time from genotype order to genotype result was 26 hours (7-80 hrs), and the time to genotype-guided dose recommendation was 30 hours (7-80 hrs). A total of 73% of warfarin doses ordered by the medical staff were within 0.5 mg of the daily dose recommended by the pharmacogenetics consult service.
  
  
  CONCLUSIONS
  Providing routine genotype-guided warfarin dosing supported by a pharmacogenetics consult service is feasible from a procedural standpoint, with most genotypes available prior to the second warfarin dose and good adherence to genotype-guided dose recommendations by the medical staff.
authors.affiliation: Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL.
authors.forename: Edith A
authors.initials: EA
authors.lastname: Nutescu
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Drozda
authors.forename: Adam P
authors.initials: AP
authors.lastname: Bress
authors.forename: William L
authors.initials: WL
authors.lastname: Galanter
authors.forename: James
authors.initials: J
authors.lastname: Stevenson
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Stamos
authors.forename: Ankit A
authors.initials: AA
authors.lastname: Desai
authors.forename: Julio D
authors.initials: JD
authors.lastname: Duarte
authors.forename: Victor
authors.initials: V
authors.lastname: Gordeuk
authors.forename: David
authors.initials: D
authors.lastname: Peace
authors.forename: Shrihari S
authors.initials: SS
authors.lastname: Kadkol
authors.forename: Carol
authors.initials: C
authors.lastname: Dodge
authors.forename: Santosh
authors.initials: S
authors.lastname: Saraf
authors.forename: John
authors.initials: J
authors.lastname: Garofalo
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Krishnan
authors.forename: Joe G N
authors.initials: JG
authors.lastname: Garcia
authors.forename: Larisa H
authors.initials: LH
authors.lastname: Cavallari
mesh_terms: D000328:Adult; D000368:Aged; D057286:Electronic Health Records / Q000592:standards; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems / Q000592:standards; D008875:Middle Aged; D010597:Pharmacogenetics / Q000379:methods* / Q000592:standards; D010607:Pharmacy Service, Hospital / Q000379:methods* / Q000592:standards; D011446:Prospective Studies; D014859:Warfarin / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D014859:Warfarin
keywords: CYP2C9; VKORC1; genotype, feasibility; implementation; pharmacogenetics; pharmacogenetics service; warfarin