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Pharmacogenetic-based dosing was associated with a higher percentage of time in the therapeutic INR range than was standard dosing during the initiation of warfarin therapy. (Funded by the European Commission Seventh Framework Programme and others; ClinicalTrials.gov number, NCT01119300.).

SummaryOf 125 patients aged 65 years or over, with atrial fibrillation taking warfarin for at least 12 months, with a standard deviation (SD) of prothrombin time, expressed as the International Normalized Ratio (INR) >0AE5 over the previous 6 months, 40 were randomized to continue with usual clinic care and 85 to receive education about warfarin. Of these, 44 were randomized to self-monitor their INR and 41 returned to clinic. Compared with the previous 6 months there was a significant increase in percentage time within the therapeutic range for the 6 months following education [61AE1 vs. 70AE4; mean difference 8AE8; 95% confidence interval (CI): )0AE2-17AE8; P ¼ 0AE054] and following education and self-monitoring (57 vs. 71AE1; mean difference 14AE1; 95% CI: 6AE7-21AE5; P < 0AE001), compared with those patients following usual clinic care (60AE0 vs. 63AE2; mean difference 3AE2; 95% CI: )7AE3-13AE7). Using the same comparative periods, the INR SD fell by 0AE24 (P < 0AE0001) in the group allocated to education and self-monitoring, 0AE26 (P < 0AE0001) in the group receiving education alone and 0AE16 (P ¼ 0AE003) in the control group. Intergroup differences were not statistically significant (intervention groups 0AE26 ± 0AE30 vs. control 0AE16 ± 0AE3, P ¼ 0AE10). Quality-of-life measurements and health beliefs about warfarin were unchanged (apart from emotional role limitation) with education or education and self-monitoring. Patient education regarding anticoagulation therapy could be a cost-effective initiative and is worthy of further study.

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