Abstract 16119: Novel Genotype Guided Personalized Warfarin Service Improves Outcomes in an Ethnically Diverse Population
Objective: Personalized warfarin dosing was implemented at UI-Health, with dosing recommendations provided by a pharmacogenetics (PGx) consult service. Our aim was to compare anticoagulation-related outcomes between patients followed by the PGx service and historical controls.
Methods: Multivariate linear, logistic, and Cox regression models were used to examine the association between exposure to the PGx service and outcomes.
Results: A total of 389 patients on the PGx service (mean age 56±16 years; 53% African American; 56% female) and 308 controls (mean age 53±16 years; 71% African American, 64% female) were included. The median (IQR) time to therapeutic INR was 4 (2-6) days in the PGx group and 11 (7-15) days in controls (p<0.001; adjusted HR 1.9; 95%CI 1.4-2.8), the time to stable dose was 21 (19-26) days in the PGx group and 25 (22-28) days in controls (p=0.04; adjusted HR 3.1; 95%CI 1.2-7.9). Patients in the PGx group were twice as likely to have a therapeutic INR on discharge compared to controls (OR 2.0; 95%CI 1.0-3.1). The mean ± SD time in therapeutic range was significantly higher in the PGx group compared to controls over the 1st seven days of therapy (14.8% ± 21.7 vs 9.6% ± 18.1; p=0.005); at 14 days and 30 days there was no difference. The mean ± SD proportion of INRs at extremes was lower in the PGx group (42.2% ± 23.7%) compared to controls (64.7% ± 25.2; adjusted β -25.1%, p<0.0001). Compared to controls, use of low molecular weight heparin (LMWH) was lower (70% versus 80%, p=0.002) and duration of LMWH therapy was shorter (adjusted β -7.5 days, 95% CI -8.8 - -6.2)] in PGx group. Our results were similar when limiting the analysis to African Americans.
Conclusion: Clinical implementation of personalized warfarin dosing improved time to therapeutic INR and stable dose, increased the likelihood of having a therapeutic INR on discharge, reduced the likelihood of INRs at extremes and led to shorter use of LMWH versus historical controls.
Author Disclosures: E. Nutescu: None. J. Duarte: None. W. Cheng: None. S. Sarangpur: None. D. Gor: None. K. Drozda: None. W. Galanter: None. T. Stamos: None. D. Peace: None. J. Garofalo: None. J. Khrishnan: None. L. Cavallari: None.
- © 2014 by American Heart Association, Inc.