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Genotype-guided warfarin dosing could improve safety

Patients receiving genotype-guided dosing of warfarin were less likely to have a major bleed or die than patients whose dosing was clinically guided.

Warfarin is a leading cause of medication-related accident and emergency visits. Experts have debated whether genotype-based warfarin dosing can prevent these adverse events.

In a recent trial published in JAMA (online, 26 September 2017), researchers randomly assigned 1,650 patients with a mean age of 72.1 years beginning warfarin at the time of elective hip or knee arthroplasty to genotype- or clinically-guided warfarin dosing[1].

They found that, during 90 days’ follow-up, patients in the genotype-guided dosing group were significantly less likely to reach the composite primary endpoint of major bleeding, an international normalised ratio of four or more, venous thromboembolism or death than those in the clinically guided group (10.8 vs 14.7%; relative rate: 0.73).

The results indicate that genotype-based dosing improved the safety of warfarin among patients undergoing elective hip or knee arthroplasty, but further research is needed to assess the cost-effectiveness of the approach, the researchers concluded.

Citation: Clinical Pharmacist DOI: 10.1211/CP.2017.20203820

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