Have you seen the article by Darlene Elias and Eric Topol (European Journal of Human Genetics)?
The title says it all, "Warfarin Pharmacogenomics: A big step forward for individualized medicine: enlightened dosing of warfarin."
Here's a link:
http://www.nature.com/ejhg/journal/vaop/ncurrent/full/5201945a.html
They applaud advances in genetic testing ... and ask some tough questions:
"In the meantime, however, a real dilemma exists for treating physicians and patients taking warfarin. Who to test and how to manage? What dosing nomogram to use? The clinical availability of the genetic testing is limited but presumed soon to be expanding. How or will the genotyping be reimbursed, given these commercially available tests are quite expensive for both CYP2C9 and VKORC1. And should all this be coordinated centrally, since studies have shown that warfarin monitoring can be improved and INR is more frequently in range with the adverse event rates lower when a centralized anticoagulation service is used compared to usual individual physician care."
We must all face these and similar issues and commence our difficult journey down the Critical Path. The future of the public health demands no less.
The title says it all, "Warfarin Pharmacogenomics: A big step forward for individualized medicine: enlightened dosing of warfarin."
Here's a link:
http://www.nature.com/ejhg/journal/vaop/ncurrent/full/5201945a.html
They applaud advances in genetic testing ... and ask some tough questions:
"In the meantime, however, a real dilemma exists for treating physicians and patients taking warfarin. Who to test and how to manage? What dosing nomogram to use? The clinical availability of the genetic testing is limited but presumed soon to be expanding. How or will the genotyping be reimbursed, given these commercially available tests are quite expensive for both CYP2C9 and VKORC1. And should all this be coordinated centrally, since studies have shown that warfarin monitoring can be improved and INR is more frequently in range with the adverse event rates lower when a centralized anticoagulation service is used compared to usual individual physician care."
We must all face these and similar issues and commence our difficult journey down the Critical Path. The future of the public health demands no less.
