Stephen E Kimmel1. 1. University of Pennsylvania School of Medicine, Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, 717 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021, USA. stevek@mail.med.upenn.edu
Abstract
BACKGROUND: Warfarin therapy has been used clinically for over 60 years, yet continues to be problematic because of its narrow therapeutic index and large inter-individual variability in patient response. As a result, warfarin is a leading cause of serious medication-related adverse events, and its efficacy is also suboptimal. OBJECTIVE: To review factors that are responsible for variable response to warfarin, including clinical, environmental, and genetic factors, and to explore some possible approaches to improving warfarin therapy. RESULTS: Recent efforts have focused on developing dosing algorithms that included genetic information to try to improve warfarin dosing. These dosing algorithms hold promise, but have not been fully validated or tested in rigorous clinical trials. Perhaps equally importantly, adherence to warfarin is a major problem that should be addressed with innovative and cost-effective interventions. CONCLUSION: Additional research is needed to further test whether interventions can be used to improve warfarin dosing and outcomes.
BACKGROUND:Warfarin therapy has been used clinically for over 60 years, yet continues to be problematic because of its narrow therapeutic index and large inter-individual variability in patient response. As a result, warfarin is a leading cause of serious medication-related adverse events, and its efficacy is also suboptimal. OBJECTIVE: To review factors that are responsible for variable response to warfarin, including clinical, environmental, and genetic factors, and to explore some possible approaches to improving warfarin therapy. RESULTS: Recent efforts have focused on developing dosing algorithms that included genetic information to try to improve warfarin dosing. These dosing algorithms hold promise, but have not been fully validated or tested in rigorous clinical trials. Perhaps equally importantly, adherence to warfarin is a major problem that should be addressed with innovative and cost-effective interventions. CONCLUSION: Additional research is needed to further test whether interventions can be used to improve warfarin dosing and outcomes.
Authors: Kamakshi Lakshminarayan; Craig A Solid; Allan J Collins; David C Anderson; Charles A Herzog Journal: Stroke Date: 2006-06-29 Impact factor: 7.914
Authors: David L Veenstra; Joyce H S You; Mark J Rieder; Federico M Farin; Hui-Wen Wilkerson; David K Blough; Gregory Cheng; Allan E Rettie Journal: Pharmacogenet Genomics Date: 2005-10 Impact factor: 2.089
Authors: Michael A Hillman; Russell A Wilke; Steven H Yale; Humberto J Vidaillet; Michael D Caldwell; Ingrid Glurich; Richard L Berg; John Schmelzer; James K Burmester Journal: Clin Med Res Date: 2005-08
Authors: G Palareti; N Leali; S Coccheri; M Poggi; C Manotti; A D'Angelo; V Pengo; N Erba; M Moia; N Ciavarella; G Devoto; M Berrettini; S Musolesi Journal: Lancet Date: 1996-08-17 Impact factor: 79.321
Authors: A P A Gadisseur; W G M Breukink-Engbers; F J M van der Meer; A M H van den Besselaar; A Sturk; F R Rosendaal Journal: Arch Intern Med Date: 2003-11-24
Authors: Stuart A Scott; Malgorzata Jaremko; Steven A Lubitz; Ruth Kornreich; Jonathan L Halperin; Robert J Desnick Journal: Pharmacogenomics Date: 2009-08 Impact factor: 2.533
Authors: Kan He; Joseph M Luettgen; Donglu Zhang; Bing He; James E Grace; Baomin Xin; Donald J P Pinto; Pancras C Wong; Robert M Knabb; Patrick Y S Lam; Ruth R Wexler; Scott J Grossman Journal: Eur J Drug Metab Pharmacokinet Date: 2011-04-02 Impact factor: 2.441
Authors: Amanda Jia Qi Ooi; Chloe Wong; Timothy Wei Ern Tan; Trina Priscilla Ng; Yao Neng Teo; Yao Hao Teo; Nicholas L Syn; Andie H Djohan; Yinghao Lim; Leonard L L Yeo; Benjamin Y Q Tan; Mark Yan-Yee Chan; Kian-Keong Poh; William K F Kong; Ping Chai; Tiong-Cheng Yeo; James W Yip; Ivandito Kuntjoro; Ching-Hui Sia Journal: Eur J Clin Pharmacol Date: 2022-08-09 Impact factor: 3.064
Authors: Peter M Bonutti; Nipun Sodhi; Yatindra H Patel; Assem A Sultan; Anton Khlopas; Morad Chughtai; Frank R Kolisek; Nick Williams; Michael A Mont Journal: Ann Transl Med Date: 2017-12