Abstract

Implementing Point-of-care Testing to Optimise Drug Treatment

Ana Alfirevic, Senior Lecturer, University of Liverpool

Application of pharmacogenetic research in the primary care setting is expected to deliver improved treatment and reduced healthcare costs. Warfarin is the most widely prescribed drug for clotting disorders in older people but its use is complicated because of its narrow therapeutic index and wide inter-individual variability in dose requirements. Both genetic and environmental factors can influence clinical response to warfarin, but there is some controversy associated with the utility of genotype-guided dosing when two recent randomised controlled trials came to opposite conclusions. To improve anticoagulation control in patients on warfarin, many different approaches have been tested. These include routine monitoring of international normalised ratio (INR) in specialized anticoagulation clinics, dosing algorithms, education programs to improve patient adherence with therapy and patient self-monitoring of INR with hand-held monitoring devices. These measures have had variable success and have not been fully implemented in clinical practice. We will discuss several approaches to improve dosing of warfarin. We are currently evaluating genotype-guided dosing in practice in a matched control study with the aim to measure improvement in patient outcomes and patient experience, and consider the implications of genotype testing for health-care providers.