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Warfarin Dosing Algorithms and the Need for Human Intervention.

Scott E Kasner1, Le Wang1, Benjamin French1

  • 1Department of Neurology and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia.

The American Journal of Medicine
|December 9, 2015
PubMed
Summary
This summary is machine-generated.

Human intervention is often needed for warfarin dosing despite algorithms. Congestive heart failure predicts early exceptions to standardized warfarin management, impacting anticoagulation control.

Keywords:
AnticoagulantsCongestive heart failurePharmacogenomicsWarfarin

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Area of Science:

  • Pharmacogenomics
  • Clinical Pharmacology

Background:

  • Warfarin dosing algorithms integrate clinical and genetic data.
  • The frequency and reasons for overriding these algorithms are not well understood.

Purpose of the Study:

  • To investigate the frequency and predictors of dose exceptions in warfarin management.
  • To determine if baseline characteristics influence deviations from algorithmic dosing.

Main Methods:

  • A prospective cohort of 1015 participants from the Clarification of Optimal Anticoagulation through Genetics trial was analyzed.
  • Participants were randomized to pharmacogenetic or clinically-guided warfarin dosing algorithms.
  • Clinicians could request exceptions to the protocol if clinically justified, with all exceptions logged and categorized.

Main Results:

  • Sixteen percent of participants required at least one dose exception.
  • Congestive heart failure was the only baseline characteristic associated with dose exceptions (OR 2.12, P <.001).
  • Neither the study arm (genotype vs. clinical) nor genetic factors were associated with dose exceptions.

Conclusions:

  • Human intervention is frequently necessary in early warfarin management, even with advanced algorithms.
  • Congestive heart failure is a significant predictor of early exceptions to standardized warfarin dosing protocols.