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Nurses using new gene test to personalise warfarin dose

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Frontline nurses in Merseyside and Cheshire are pioneering the use of gene testing to prescribe and administer individualised dosages of warfarin.

The initiative is being led by researchers at the University of Liverpool, and involves using a simple saliva test to examine specific genes that influence the body’s response to the blood-thinning drug.

“A simple mouth swab provides DNA which can now be analysed by nurses in a single, easy-to-use procedure”

Simon Wells

It is the first time genotyping by frontline nursing staff has been used in the provision of drug dosing to patients in the UK, according to the university, which said the move heralded “a new era in personalised medicine”.

It has been estimated that at least 1% of the UK population and 8% of those aged over 80 years are taking warfarin.

Commonly, due to the well-known dosing difficulties associated with the drug, a patient will attend a clinic six to eight times before the correct dose is established.

The new initiative has developed from a successful international trial in Liverpool, Newcastle and Sweden, which included genotype testing of patients into an algorithm to calculate dosages. The trial results have previously been published in the New England Journal of Medicine.

Clinics in the Royal Liverpool University Hospital – where the trial was conducted – Warrington Hospital and the Countess of Chester Hospital are now genotyping new patients with atrial fibrillation before prescribing warfarin.

Professor Sir Munir Pirmohamed, from Liverpool University, who is leading the work, said: “This is innovation and it is disruptive; it is a way of personalising care which can be replicated in many areas of medicine, creating a major paradigm shift in how we diagnose and treat people.

Liverpool University

Nurses using new gene test to personalise warfarin dose

Professor Sir Munir Pirmohamed

“This is how we get patients onto the right drugs at the right doses – using ‘precision dosing’ so that they are effective,” he said. “This improves the treatment of patients and improves the efficiency of existing and new drugs.”

The process involves using desktop ParaDNA equipment, made by international testing company LGC, which gives a genotyping result from a saliva sample in 45 minutes.

Dr Simon Wells, business unit director for ParaDNA at LGC, described the technology development as a “milestone in patient care”.

“A simple mouth swab provides DNA which can now be analysed by nurses in a single, easy-to-use procedure,” he said.

Since the process was introduced in March and up to September, 61 patients have undertaken the genotype test before being prescribed warfarin.

The real-world testing of the use of genotyping is being monitored and evaluated, with the aim of introducing it routinely across the UK. The evaluation results will be published after March 2017.

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Readers' comments (2)

  • Pussy

    " Blood thinning!!!" This is a professional journal and not the Daily Mail! Why are you using such childish terms? Unbelievable! Really NT!

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  • Wonder how effective this will be for Antiphopholipod syndrome especially those who need INR to be between 3-4 as these patients have to stay on Warfarin and cannot take the new drugs such as rivaroxiban? Will this testung be sfe and ensure there are no side effects such as brain fog and micro clots in the brain and other organs?

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