Will there be a role for genotyping in warfarin therapy?

Purpose of review In North America warfarin is the current standard for oral anticoagulation therapy in the treatment and/or prophylaxis of different thrombotic conditions. In daily clinical practice a significant proportion of patients on long-term warfarin therapy fail to stabilize within their target therapeutic range leading to a resultant increased risk of thromboembolism or bleeding. Various authors and agencies advocate the role of genetic testing to guide warfarin dosing. Recent findings Evidence regarding the clinical efficacy and cost-effectiveness of genotype-based warfarin dosing has been conflicting, although some recent studies have suggested a potential benefit in certain subgroups. Summary More evidence is needed before the wide adoption of genotype-based warfarin dosing. Future studies should be designed to address outcomes such as major bleeding or recurrent thrombosis, and allow economic evaluations.