B F Gage

..001). In conclusion, the maintenance warfarin dose can be estimated from demographic, clinical, and pharmacogenetic factors that can be obtained at the time of warfarin initiation...

..Thus, a comprehensive dosing algorithm offers the most promising approach to estimating the therapeutic dose of warfarin a priori and to preventing hemorrhage during warfarin induction...

..Patients at high risk for falls are presumed to be at increased risk for intracranial hemorrhage, and high risk for falls is cited as a contraindication to antithrombotic therapy. Data substantiating this concern are lacking...

..Vitamin K antagonists such as warfarin inhibit this process. Our goal was to quantify the association between warfarin and osteoporotic fractures in patients with atrial fibrillation...

..Our objective was to find a bleeding classification scheme that could quantify the risk of hemorrhage in elderly patients with atrial fibrillation...

..The FDA completed the label update in August 2007...

..To facilitate use of these pharmacogenetic and clinical algorithms, we developed a nonprofit website, http://www.WarfarinDosing.org...

..This prospective cohort study tested the predictive accuracy of 5 stroke risk stratification schemes...

..Recent studies have investigated alternatives to warfarin for stroke prophylaxis in patients with atrial fibrillation (AF), but whether these alternatives are cost-effective is unknown...

..Patients who have atrial fibrillation (AF) have an increased risk of stroke, but their absolute rate of stroke depends on age and comorbid conditions...

..Finally, when the patient develops dental pain, we review the analgesic agents that are safe to take with warfarin and explain why warfarin therapy does not have to be interrupted during a subsequent dental extraction...

..Experts have hypothesized that genotype becomes irrelevant once international normalized ratio (INR) values are available because INR response reflects warfarin sensitivity...

..14, one-sided P = 0.03). CALU rs339097 A>G is associated with higher warfarin dose requirements, independent of known genetic and nongenetic predictors of warfarin dose in African Americans...

..002). After several days of therapy, a pharmacogenetic algorithm estimates the therapeutic warfarin dose more accurately than one using clinical factors and INR response alone...

..To compare the satisfaction and knowledge of patients who have their warfarin managed by their physician or by a multidisciplinary, telephone-based anticoagulation service (ACS) and to assess referring physicians' satisfaction with the ACS...

..Prospective, perioperative pharmacogenetics-based dosing of warfarin is feasible; however, further evaluation in a randomized, controlled study is recommended...

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..The preference-based strategy prescribed whichever antithrombotic therapy, warfarin or aspirin, had the greater projected quality-adjusted survival...

..048). CONCLUSIONS: The use, monitoring, and effectiveness of warfarin therapy are suboptimal in Medicare beneficiaries, especially in black and Hispanic beneficiaries...

..Warfarin is commonly prescribed for prophylaxis and treatment of thromboembolism after orthopedic surgery. During warfarin initiation, out-of-range International Normalized Ratio (INR) values and adverse events are common...

..A comprehensive pharmacogenetics approach to warfarin therapy has the potential to improve the safety and efficiency of warfarin initiation...

..Current commercial platforms provide accurate and rapid genotypes for pharmacogenetic dosing during initiation of warfarin therapy...

..CONCLUSION: The predictive accuracy of 3 administrative-data based indices was similar and comparable with chart-review...

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..Baseline prediction of bleeding risk can complement ischemic risk prediction for optimization of NSTEMI care; however, existing models are not well suited for this purpose...

..Dosing algorithms have not been widely adopted because they require a fixed initial warfarin dose (eg, 5 mg) and are not tailored to other factors that may affect the international normalized ratio (INR)...

..Our findings suggest that HMOs can safely substitute at least 1 generic formulation of warfarin without extra monitoring...

..If validated, this model should provide a safer, more effective process for initiating warfarin therapy...

..The extent to which chronic atrial fibrillation affects the risk of postoperative stroke is largely unknown...

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..Although this hypothesis is anticipated to decrease the use of ventilation-perfusion (VQ) scans and other diagnostic tests for PE, it has not been tested in a "real-world" environment...

..Explicit criteria exist for outpatient DVT therapy. Home therapy for PE requires further evaluation before it can be recommended outside of a trial or other supervised setting...

..This investigation assessed the reliability of the current LRSG system by determining inter- and intrareader agreement for grading transbronchial biopsy samples from lung transplant recipients...

..The genotype assays for genetic variants relevant to warfarin are widely used and are being developed for commercial use (5), making the promise of a pharmacogenetics-based approach a near reality...

..Anemia is an independent predictor of mortality and morbidity for numerous cardiovascular and noncardiovascular diseases, but the association of anemia with mortality and hospitalizations in patients with AF requires clarification...

..Where feasible, review of additional data (eg, physician notes or imaging studies) should be used to confirm the diagnosis of valvular disease, arterial peripheral embolus, intracranial hemorrhage, and deep venous thrombosis...

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..The frequency and causes of ab- errant International Normalized Ratios (INRs) in warfarin recipients and the percentage explainable by warfarin nonadherence were studied...

..These data suggest that in patients 80 years and older who are hospitalized with acute myocardial infarction, an invasive strategy confers a significant survival advantage during the first year after hospital discharge...

..3, and reducing the dose for patients who have a greater INR or an increased risk of hemorrhage. Warfarin dose reductions > 20% should be avoided for mildly elevated INRs...

..The purpose of this study was to evaluate the long-term outcomes of patients with unexplained syncope, ischemic or nonischemic cardiomyopathy, and a negative electrophysiologic study (EPS)...

..Reduced SPP reserve identified patients who are at high risk for experiencing progressive HF...

..The cost savings and potential improvement in quality of care argue for equipping home health nurses with portable coagulometers...

..During ongoing therapy with coumarins, the risks and benefits of therapy should be reassessed periodically. This article reviews the current evidence for the prediction and prevention of coumarin-related bleeding...

..Traditional predictors of mortality in patients with reduced LVEF may not apply to elderly patients with preserved LVEF...

..A randomized controlled trial is needed to evaluate the potential benefits of EPO use in patients with ARF...

..To develop and to evaluate selection criteria for outpatient management of deep venous thrombosis (DVT)...

..Extended Medicare immunosuppression coverage to the life of a kidney transplant should result in better transplant and economic outcomes, and should be considered by policy makers...

..The authors conclude that anemia is not an important predictor of long-term survival in very elderly patients hospitalized with HF...

..The management of patients who undergo endoscopy while being treated with warfarin is challenging. We used decision analysis to determine the preferred strategy to manage anticoagulants in the periendoscopic period...

..The authors compared the thresholds for antithrombotic treatment from studies that determined or modeled the treatment preferences of patients with atrial fibrillation with recommendations from clinical practice guidelines...

..The management of warfarin therapy is complicated by a wide variation among patients in drug response. Variants in the gene encoding vitamin K epoxide reductase complex 1 (VKORC1) may affect the response to warfarin...

..Genetic variation of CYP4F2 was associated with a clinically relevant effect on warfarin requirement...

..The objective of this study was to assess the predictive value of stroke risk classification schemes and to identify patients with atrial fibrillation who are at substantial risk of stroke despite optimal anticoagulant therapy...

..Additional research to identify an optimum scheme for primary prevention and subsequent standardization of recommendations may lead to more uniform selection of patients for anticoagulant prophylaxsis...

..Using high performance liquid chromatography, we will measure the levels of the 2 enantiomers of warfarin and test Hypothesis 4: Clearance of S-warfarin will be significantly decreased in the presence of 2C9 SNPs. ..