Using genetic testing to guide warfarin therapy
Lisa L. Ungerer BSN, RN
Elizabeth L. Pestka RN, PMHCNS-BC, APNG
Penny K. Messner DNP, RN, ACNS-BC

May 2012 
Volume 42  Number 5
Pages 63 - 65
  PDF Version Available!

You're caring for Ms. M, who had heart valve replacement surgery yesterday. As you administer warfarin, an anticoagulant medication used to prevent and treat thrombosis, Ms. M mentions that her father had a stroke while taking warfarin for atrial fibrillation. She asks you whether genetic testing is available to determine her risk for experiencing a similar reaction. How would you respond? This article will provide some helpful information.Nurses need to know about genetics (single gene disorders) and genomics (interactions of all of the genes in the human genome with each other and with environmental factors) in order to respond to queries from patients and their family members. A rapidly growing body of genetic and genomic research findings is providing evidence to explain why some patients are at greater risk for diseases and conditions. Genetic testing has expanded to include pharamacogenetic testing, which can provide information about which medication and dose may work best for a patient based on the patient's genetic makeup. Warfarin dosing is now based on a patient's age, race, weight, diet, medical conditions, and concurrent medications. Pharmacogenetic testing can be used to further individualize the dose.1 Identifying a therapeutic dose of warfarin for a patient is important, especially in the initial dose adjustment phase. Warfarin can cause life-threatening complications, such as stroke and bleeding, because it has a very narrow therapeutic index.About 2 million Americans are started on warfarin therapy annually.2 Warfarin is the second leading drug-related reason for ED visits and the most frequently cited cause for drug-related mortality.3,4 Research over the last 10 years has identified variations in two genes that have been shown to have an important effect on individual response to warfarin. A person has two copies of each of these genes: one inherited from their mother and one from their father. The first identified gene is the isoenzyme cytochrome

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