Implementation of a Multidisciplinary Warfarin Pharmacogenetics Service at the University of Illinois Hospital & Health Sciences System (UI-Health)

Background: Genotype-guided warfarin dosing has the potential to improve dosing accuracy, shorten the time to dose stabilization, allow for more informed dose titration, reduce the risk for bleeding, and help identify individuals who require more frequent monitoring. Despite guidelines from the Clinical Pharmacogenetics Implementation Consortium and inclusion of genotype-guided dosing recommendations in the warfarin product labeling, clinical implementation of warfarin pharmacogenetics has been lagging in practice. The nuances of considering both genetic and clinical factors for warfarin dose estimation requires a level of expertise to support clinical decision making that can be best provided via a specialized clinical pharmacogenetics service.  Additional considerations in underrepresented minority patients (as in our population) also need to be factored in.

Purpose: To develop a coordinated, genotype-guided dosing and management approach and implement a clinical pharmacogenetics service for warfarin therapy.

Methods:   A multidisciplinary team consisting of experts from pharmacogenetics, anticoagulation, clinical pathology, systems engineering, information technology, bioinformatics, and hospital administration was formed to develop strategies for implementing a warfarin pharmacogenetic service. Service responsibilities include selecting genotyping methodology, validating genetic tests, building the information technology infrastructure to support genetic testing, coordinating provider education, providing consultative services, serving as an information resource to support clinical decision making, exploring methods to improve workflow, and examining use of ancestry-specific dosing models.

Results: The development and implementation of a multidisciplinary clinical pharmacogenetics service for warfarin therapy will be described.

Conclusion: Given our diverse patient population, implementation of warfarin pharmacogenetics provides a unique opportunity to examine the feasibility and optimize the delivery of genotype-guided medicine to underrepresented patient populations, with the ultimate goal of reducing health care disparities and improving patient outcomes. This UI-Health initiative to implement warfarin pharmacogenetics is among the first and is consistent with our commitment to providing personalized medicine and translating genetic information to optimal medication management.