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CPIC® Guideline for Pharmacogenetics-Guided Warfarin Dosing

Most recent guideline publication:

Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for Pharmacogenetics-guided Warfarin Dosing: 2016 Update (December 2016)

Updates since publication:

No updates on dosing recommendations since this publication.

Figures provided in the main manuscript of the guideline:

Figure 1. Schematic representation of warfarin metabolism and its mechanism of action.
Figure 2. Dosing recommendations for warfarin dosing based on genotype for adult patients
Figure 3. Dosing recommendations for warfarin dosing based on genotype for pediatric patients

Supplement to: Clinical Pharmacogenetics Implementation Consortium (CPIC) Guidelines for Pharmacogenetics-guided Warfarin Dosing: 2016 Update

Tables provided in the guideline publication supplement or referenced in the guidelinea:

Supplemental Table S1. Evidence linking CYP2C9 to warfarin phenotype
Supplemental Table S2. Evidence linking VKORC1 to warfarin phenotype
Supplemental Table S3. Evidence linking CYP4F2 to warfarin phenotype
Supplemental Table S4. Evidence comparing pharmacogenetics warfarin dosing algorithms to standard of care dosing or clinical algorithms
Supplemental Table S5. Primary pharmacogenetics warfarin dosing algorithms used in prospective clinical trials
Supplemental Table S6. Additional findings with weak/moderate evidence linking other genes/variants to warfarin phenotype (not part of recommendation)
Supplemental Table S7. Evidence Linking CYP2C9, VKORC1, and CYP4F2 to warfarin phenotype in pediatric patients
CYP2C9 allele definition table
CYP2C9 frequency table
The CYP2C9 diplotype to phenotype table is not applicable to this guideline.
VKORC1 allele definition table
VKORC1 allele functionality table
VKORC1 frequency table
VKORC1 does not have a diplotype to phenotype table.b
CYP4F2 allele definition table
CYP4F2 allele functionality table
CYP4F2 frequency table
CYP4F2 does not have a diplotype to phenotype table.b

Gene Resource Mapping

CYP2C9 gene resource mapping

VKORC1 gene resource mapping

CYP4F2 gene resource mapping

 Drug Resource Mapping

Warfarin drug resource mapping

aSome of the tables included in the guideline may have been updated on-line, particularly to reflect newly described or newly characterized alleles. These include the gene-specific information tables (https://www.pharmgkb.org/page/pgxGeneRef) that support CPIC guidelines by providing information regarding star (*) allele definitions, allele function, allele frequency by major ethnic groups, translations of diplotype to phenotype, and gene resource mappings.

bBecause this guideline’s recommendations are based on genotype and not phenotype, the diplotype-phenotype tables were not created for these genes.

Original publication (October 2011):

November 2013 update to 2011 guideline:
CPIC guideline authors are aware of several recently published studies on warfarin pharmacogenetics [Articles:24251361, 24251363, 24251360]. These papers have prompted several opinion pieces [Articles:24328463, 24251364]. The authors are evaluating the information, which will be incorporated into the next update of the CPIC guideline on warfarin.

This guideline has been endorsed by the American Society of Health-System Pharmacists (ASHP).