1. Jacee Robison1, MS, BSN, RN; Jia-Wen Guo2, PhD, RN
Critical Factors For Developing A Personalized Warfarin Dosing Protocol: A Scoping Review Analysis
Jacee Robison1, MS, BSN, RN; Jia-Wen Guo2, PhD, RN
13M Health Information Systems, Inc., Murray, Utah, U.S.A
2University of Utah College of Nursing, Salt Lake City, Utah, U.S.A
Therapeutic ranges vary depending on the disorder that the patient has. Variance of range in those with a-fib, heart valve replacements, DVT’s, PE’s, etc.
Background
Results
Majority of Warfarin dosing protocols were inconsistent across settings
Factors included vary among protocols
Four main domains were suggested for developing a personalized Warfarin dosing protocol: Genomics, Demographics, Health Behaviors, and Clinical Factors
Warfarin is commonly prescribed in the U.S.
Warfarin has a narrow therapeutic range which requires frequent lab work and adjustments
Warfarin has serious risks (bleeding, clots)
There is a need for dosing protocols that facilitate risk reduction and improve outcomes
Objective
Identify the critical factors that need to be considered when developing a protocol for personalized Warfarin dosing from existing literature and clinical guidelines
Conclusions
Methods
Scoping Review
Following Arksey and O’Malley’s framework
Databases: PubMed, CINAHL, and Google Scholar
Search terms: “Pharmacogenomic”, “Warfarin”, “Adult”, “Standard”, “Protocol”, “Personalized Medicine” and “Precision Medicine”
Inclusion criteria: Full text, >2007
Results: 16,854 articles, 12,424 excluded, 252 reviewed, 32 included
Content analysis
32 articles were reviewed
Inter-reviewer reliability:
Agreement: 0.99
Cohen’s Kappa: 0.93
More research is needed to improve safety of Warfarin dosing in patients
Interdisciplinary collaboration to form a comprehensive “Gold Standard” protocol
Develop Warfarin Clinical Decision Support Systems that include essential factors
Comparative effectiveness research studies to address and evaluate Warfarin protocols
Dosing protocols utilizing a theoretical framework to guide process design
Contact Information
Jacee Robison:
Jia-Wen Guo: