Optimizing Time in Therapeutic Range in Patients With HeartMate 3: Pharmacist-Led Anticoagulation Using Pharmacogenetics of Warfarin.

CYP2C9 (reduced-function alleles) and VKORC1 genotypes modulate warfarin dose requirements; accounting for them before initiation guides dosing.

Time in therapeutic range (TTR) on warfarin is frequently suboptimal in patients supported with a HeartMate 3 left ventricular assist device, increasing bleeding and thromboembolic risk. This single-center prospective randomized trial compared clinical pharmacist-led anticoagulation with pre-initiation genotyping of CYP2C9 and VKORC1 (intervention group) versus usual physician-led care with genotype kept blinded (control group). Among 41 patients completing the study (18 intervention, 23 control), 12-week TTR was 78.1 % in the intervention group versus 67.1 % in the control group (P < 0.05). Pharmacist-led management incorporating warfarin pharmacogenetics significantly improved TTR.

Synthesis written by Geno'X. For the full original abstract, please refer to the source publication.

This randomized trial showing a TTR benefit combines two levers: preemptive CYP2C9/VKORC1 genotyping (CPIC level A recommendation for warfarin) and pharmacist-led management. The cohort is modest and single-center, but in a high-bleeding-risk LVAD population the TTR improvement is clinically meaningful. The bundled design prevents isolating the specific contribution of pharmacogenetics.

Analysis by Dr Thibaut Benquey