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.
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