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Patient Specific anticoagulation not better than Usual blood thinning using algorithm

By: Dr. Christopher Ho on March 7, 2014, 5:07 pm

As Hematologists in the West Hills, Calabasas, and Tarzana neighborhoods, our patients ask us in regards to options in blood thinning or anticoagulation. 

Anticoagulation has been used for many years, and coumadin has remained a mainstay in our fight against blood clots which can cause strokes and clots to the lung which can be dangerous. 

A drawback to coumadin, is that it can be unpredictable in dosages, since patients can vary as to how they are able to metabolize the medication from their system. 

Scientists and Doctors have been at work trying to see if through genetic analysis if a specific dose of designed just for the patient may be superior than just adjusting based on lab results. 

Unfortunately, it seems as though the dosing based upon genetic analysis proved no better and was published here:

http://www.nejm.org/doi/full/10.1056/NEJMoa1310669

What does this mean? It DOESN'T mean that coumadin is not effective medication, it is very effective. Perhaps we have become so adept at adjusting the dose that genetic testing doesn't matter. 60 years of experience with a medication must mean something.

In addition, there are new alternatives which generally do not require adjustments either. However, it will be a long time before we develop the experience that we have developed over the year with coumadin.