FDA labeling of warfarin includes to consider genetic testing when initiating warfarin, although few patients are offered this testing. Over 30 genes contribute to warfarin dosing effects, but 1/3 of the variance is controlled by polymorphisms in 2 genes: cytochrome P450 (CYP2C9) and vitamin K epoxide reductase (VKORC1). In this cost-effective analysis (abstract), the authors determine that testing afib patients for these 2 genes upon initiation of warfarin (with genotype-guided dosing), is only cost-effective if their risk of bleeding is high (HEMORR2HAGES score >1) (abstract), depending on the cost of the testing. Currently the cost of such testing is about $400, so should be considered ONLY in patients at high risk for bleeding.
What comes to mind when you think of getting CME? I bet most of you would say sitting in an auditorium, whether that be during your local grand rounds or at our professional society meeting, like Hospital Medicine 16 in sunny San Diego this past March. Hanging out in the Twitterverse? Probably not so much… […]
As a nurse practitioner in hospital medicine I have multiple opportunities to interact with all sorts of physician hospitalist colleagues, hospital medicine group leaders, quality officers etc. Often their interactions with me take on a certain wary curiosity, like I am some exotic monkey or another creature that is unfamiliar to them. If I am […]
By reading the headlines recently, practitioners would not know if they saved or tanked the healthcare system. One day disaster looms, the next we have moderated growth and business can continue as usual (and by business, I mean doing the correct things correctly). A new study, along with some recent data, helps shed some light […]