Pharmacist-Guided Pharmacogenetic Service Lowered Warfarin-Related Hospitalizations

Abstract

Background: The authors aimed to assess outcomes with a pharmacogenetic (PGx)-informed, pharmacist-guided, personalized consult service for warfarin dosing. Methods: This retrospective cohort study included patients admitted with thromboembolic events. Eligible subjects received either PGx-informed (n = 389) or historical non-PGx pharmacist-guided warfarin dosing (Hx; n = 308) before hospital discharge. The composite of admission with bleeding or thromboembolic events over 90 days after the discharge was compared between the PGx and Hx groups. Results: The rate ratio (95% CI) of the composite of bleeding or thromboembolic admissions for PGx versus Hx was 0.32 (0.12–0.82). The estimated hazard ratio was 0.43 (0.16–1.12). Conclusion: A PGx-informed warfarin dosing service was associated with decreased bleeding and thromboembolic encounters.

Keywords::

• adverse events
• anticoagulation
• bleeding
• pharmacist-guided personalized consult service
• pharmacogenetic
• thrombosis
• warfarin

Author contributions

All authors jointly developed the initial research and analysis plan. The initial research protocol was reviewed and modified by all authors. K Kim, JD Duarte and EA Nutescu extracted analytic cohorts from the electronic healthcare records. K Kim performed statistical analyses. All authors drafted, reviewed and revised this manuscript together. The overall research project was supervised by LH Cavallari and EA Nutescu. K Kim is responsible for the overall content as guarantor.

Acknowledgments

Shishir Chandra Sarangpur, a UIC PSOP program graduate, extracted data from the electronic healthcare records. He also cleaned the research data obtained from the structured field of the electronic healthcare records. The authors also acknowledge the contributions of Priyam Patel and Patrick Costello, who assisted in the manual review of the electronic healthcare records. Nina Galanter assisted investigators in data review and cleaning.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations.

Data sharing statement

Data are available upon reasonable request. Any patient-level data sharing will be subject to the author’s institutional policy. All summary data relevant to the study are included in the article or uploaded as supplementary information.