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AuthorFahmi, Amr Mohamed
AuthorElewa, Hazem
AuthorEl Jilany, Islam
Available date2023-03-28T08:57:58Z
Publication Date2022-06-01
Publication NameInternational Journal of Clinical Pharmacy
Identifierhttp://dx.doi.org/10.1007/s11096-022-01386-8
CitationFahmi, A., Elewa, H. & El Jilany, I. Warfarin dosing strategies evolution and its progress in the era of precision medicine, a narrative review. Int J Clin Pharm 44, 599–607 (2022). https://doi.org/10.1007/s11096-022-01386-8
ISSN22107703
URIhttps://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85125640715&origin=inward
URIhttp://hdl.handle.net/10576/41371
AbstractBackground For decades, vitamin K antagonists and specifically warfarin, have been the sole agents used orally to manage thromboembolic conditions, including stroke and venous thromboembolism (VTE). Several factors lead to warfarin dose variability, including genetic and non-genetic factors which made warfarin management challenging especially at the initiation phase. To overcome the challenges with warfarin dosing at initiation, strategies other than conventional or fixed dosing were introduced and explored. Aim In this narrative review, we aim to discuss and critique the different dosing strategies for warfarin at initiation with more focus on genotype-guided warfarin dosing and the most recent supporting evidence for and against its use. Method Medline database was searched from 1965 to July 2021. Articles addressing different warfarin dosing methods were screened for inclusion. Results A number of methods exist for warfarin initiation. Studies comparing different dosing methods for initiation yielded conflicting outcomes due to differences in study design, population studied, comparator, and outcomes measured. Conclusions Looking at the big picture, the use of genetic dosing for warfarin initiation can lead to better outcomes. Whether these better outcomes are clinically or economically beneficial remains controversial.
SponsorOpen Access funding provided by the Qatar National Library. Grant: IRGC-06-JI-19-205 (Qatar).
Languageen
PublisherSpringer
SubjectCYP2C9
Genetic-guided warfarin dosing
VKORC1—CYP4F2
Warfarin clinical dosing
Warfarin dosing algorithms
Warfarin fixed dosing
TitleWarfarin dosing strategies evolution and its progress in the era of precision medicine, a narrative review
TypeArticle Review
Pagination599-607
Issue Number3
Volume Number44
dc.accessType Open Access


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