Genetic testing for warfarin dosing? Not yet ready for prime time.

摘要: Specifically, the report concludes, “We estimatethat formally integrating genetic testing intoroutine warfarin therapy could allow Americanwarfarin users to avoid 85,000 serious bleedingevents and 17,000 strokes annually. We estimatethe reduced health care spending from inte-grating into be$1.1 billion annually, with a range of about $100million $2 billion.”So, what’s story? Can beused determine right dosage?Does such an approach reduce clinical compli-cations save industry billionsof dollars annually? The answer, quite simply, ismaybe, but no one knows for sure. Although theconcept may be attractive this evolving areaneeds researched, good data tosupport use warfarindosing are not yet available. Also, it is importantto realize that impressive conclusions fromthe Brookings mentioned above arebasedon supposition projections, on solidclinical outcome data. Furthermore, someexperienced clinicians question whether genetictesting adds significantly information onemay discern by carefully monitoring inter-national normalized ratio (INR) takinginto consideration numerous patient-specificfactors influence dosing require-ments, as age, underlying disease states, andconcomitant drugs.