Pharmacogenomic Warfarin Dosing: Worth the Cost?

Mark J. Alberts, MD


December 23, 2013

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Hello, and welcome to this Medscape stroke update. I am Dr. Mark Alberts, Vice Chair of Neurology at University of Texas Southwestern in Dallas.

Today, I want to talk about 3 related studies published in the November 17 online version of the New England Journal of Medicine. [1,2,3]

These very similar studies compared dosing of warfarin using a genetic testing model vs a routine clinical algorithm. In all 3 studies, patients who were enrolled had typical atrial fibrillation or another thromboembolic event or risk necessitating treatment with warfarin.

Investigators from the 3 studies used genetic testing vs routine clinical protocol to assess patients to determine the dose of warfarin the patient should receive. Typically, the primary endpoint was the time that it took to get the patients into a therapeutic range -- an international normalized ratio (INR) of 2-3 -- or the time that they stayed within a therapeutic range (again, an INR of 2-3). Secondary endpoints in all of these studies were clinically important outcomes such as ischemic or hemorrhagic events. In total, the 3 studies included slightly more than 2000 patients.


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