Implementing Algorithm-Guided Warfarin Dosing in an Ethnically Diverse Patient Population Using Electronic Health Records and Preemptive CYP2C9 and VKORC1 Genetic Testing.
A. Owusu Obeng,A. Owusu Obeng,Tom Kaszemacher,Noura S. Abul-Husn,Omri Gottesman,Aida Vega,Eva Waite,Kristin Myers,Judy H. Cho,Erwin P. Bottinger,Steve Ellis,Stuart A. Scott +11 more
TL;DR: A strategy that accounts for the complexity of race and leverages electronic health records for algorithm variables and deploying point‐of‐care dose recommendations is developed to facilitate multiethnic algorithm‐guided warfarin dosing using preemptive genetic testing.
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Abstract: Implementation of pharmacogenetic-guided warfarin dosing has been hindered by inconsistent results from reported clinical trials and a lack of available algorithms that include alleles prevalent in non-white populations. However, current evidence indicates that algorithm-guided dosing is more accurate than empirical dosing. To facilitate multiethnic algorithm-guided warfarin dosing using preemptive genetic testing, we developed a strategy that accounts for the complexity of race and leverages electronic health records for algorithm variables and deploying point-of-care dose recommendations.
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Personalized Medicine and the Power of Electronic Health Records.
TL;DR: Advances in the digitization of health information and the proliferation of genomic research in health systems are reviewed and insights are provided into emerging paths for the widespread implementation of personalized medicine.
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Institutional profile: translational pharmacogenomics at the Icahn School of Medicine at Mount Sinai.
Stuart A. Scott,Stuart A. Scott,Aniwaa Owusu Obeng,Aniwaa Owusu Obeng,Mariana R. Botton,Mariana R. Botton,Yao Yang,Yao Yang,Erick R. Scott,Erick R. Scott,Stephen B. Ellis,Richard Wallsten,Tom Kaszemacher,Xiang Zhou,Xiang Zhou,Rong Chen,Rong Chen,Paola Nicoletti,Paola Nicoletti,Hetanshi Naik,Eimear E. Kenny,Aida Vega,Eva Waite,George A. Diaz,George A. Diaz,Joel T. Dudley,Jonathan L. Halperin,Lisa Edelmann,Lisa Edelmann,Andrew Kasarskis,Jean-Sébastien Hulot,Jean-Sébastien Hulot,Inga Peter,Erwin P. Bottinger,Kurt Hirschhorn,Pamela Sklar,Judy H. Cho,Robert J. Desnick,Robert J. Desnick,Eric E. Schadt,Eric E. Schadt +40 more
TL;DR: This overview summarizes the current state of translational pharmacogenomics at Mount Sinai, including a future outlook on the forthcoming expansions in overall support, research and clinical programs, genomic technology infrastructure and the participating faculty.
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Polymorphisms of VKORC1 and CYP2C9 are associated with warfarin sensitivity in Chinese population.
TL;DR: In obese patients and in obese patients, warfarin maintenance doses were significantly higher than in the others, and in VKORC1 1173CT, 1542GC, 2255CT and 3730CT polymorphisms were detected in same patients, but CYP2C9 exon 4 −65GC carriers were different from them.
Electronic Health Record-Integrated Clinical Decision Support for Clinicians Serving Populations Facing Health Care Disparities: Literature Review
Carole H. Stipelman,Polina V. Kukhareva,Elly Trepman,Quang-Tuyen Nguyen,Lourdes Valdez,Colleen Kenost,Maia Hightower,Kensaku Kawamoto +7 more
- 01 Aug 2022
TL;DR: In this paper , a review of clinical decision support (CDS) integrated or interoperable with an electronic health record (EHR) to improve health care for populations facing disparities is presented, highlighting the need for high-quality analyses of CDS-associated health outcomes.
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References
Warfarin Pharmacogenetics: An Illustration of the Importance of Studies in Minority Populations
TL;DR: Clinical translation in non-Europeans can be challenging, and studies in minorities are essential as they present opportunities for discovery that would be missed through European-only studies, and they ensure that all populations benefit from clinical pharmacogenetics.
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Warfarin pharmacogenetic trials: is there a future for pharmacogenetic-guided dosing?
Stuart A. Scott,Steven A. Lubitz +1 more
TL;DR: “In clinical practice, it is common for warfarin to be initiated at a fixed dose for the first several doses,” says the report.
The CLIPMERGE PGx Program: Clinical Implementation of Personalized Medicine Through Electronic Health Records and Genomics–Pharmacogenomics
Omri Gottesman,Stuart A. Scott,Stephen B. Ellis,Casey Lynnette Overby,Angelika Ludtke,Jean-Sébastien Hulot,Jeffrey Hall,Kumar Chatani,Kristin Myers,Joseph L. Kannry,Erwin P. Bottinger +10 more
TL;DR: The CLIPMERGE PGx Program is establishing a best‐practices infrastructure for the implementation of genome‐informed prescribing using a biobank‐derived clinical cohort, preemptive genetic testing, and real‐time clinical decision support deployed through the electronic health record.
Design and anticipated outcomes of the eMERGE-PGx project: a multicenter pilot for preemptive pharmacogenomics in electronic health record systems.
Laura J. Rasmussen-Torvik,Sarah C. Stallings,Adam S. Gordon,Berta Almoguera,Melissa A. Basford,Suzette J. Bielinski,Ariel Brautbar,Murray H. Brilliant,David Carrell,John Connolly,David R. Crosslin,Kimberly F. Doheny,Carlos J. Gallego,Omri Gottesman,Daniel Seung Kim,Kathleen A. Leppig,Rongling Li,Simon Lin,Shannon Manzi,Ana R. Mejia,Jennifer A. Pacheco,Vivian Pan,Jyotishman Pathak,Cassandra Perry,Josh F. Peterson,Cynthia A. Prows,James D. Ralston,Luke V. Rasmussen,Marylyn D. Ritchie,Senthilkumar Sadhasivam,Senthilkumar Sadhasivam,Stuart A. Scott,Maureen E. Smith,Aida Vega,Alexander A. Vinks,Alexander A. Vinks,Simona Volpi,Wendy A. Wolf,Erwin P. Bottinger,Rex L. Chisholm,Christopher G. Chute,Jonathan L. Haines,John B. Harley,John B. Harley,Brendan J. Keating,Ingrid A. Holm,Ingrid A. Holm,Iftikhar J. Kullo,Gail P. Jarvik,Eric B. Larson,Teri A. Manolio,Catherine A. McCarty,Deborah A. Nickerson,Steven E. Scherer,Marc S. Williams,Dan M. Roden,Joshua C. Denny +56 more
TL;DR: The design and initial implementation of the eMERGE‐PGx project is described, including site‐specific project implementation and anticipated products, including genetic variant and phenotype data repositories, novel variant association studies, clinical decision support modules, clinical and process outcomes, approaches to managing incidental findings, and patient and clinician education methods.
Clinical Pharmacogenetics Implementation Consortium Guidelines for CYP2C9 and VKORC1 Genotypes and Warfarin Dosing
Julie A. Johnson,Li Gong,Michelle Whirl-Carrillo,Brian F. Gage,Stuart A. Scott,Charles M. Stein,Jeffrey L. Anderson,Stephen E. Kimmel,Ming Ta Michael Lee,Munir Pirmohamed,Mia Wadelius,Teri E. Klein,Russ B. Altman +12 more
TL;DR: The purpose of this article is to assist in the interpretation and use of CYP2C9 and VKORC1 genotype data for estimating therapeutic warfarin dose to achieve an INR of 2–3, should genotype results be available to the clinician.