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July 12, 2026Annals of Pharmacotherapy

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

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Why the study?

Suboptimal time in therapeutic range (TTR) during warfarin anticoagulation is frequently observed in patients with HeartMate 3 LVADs and is associated with increased bleeding and thromboembolic events.

Does pharmacist-led warfarin management using pharmacogenetic testing improve time in therapeutic range in patients with HeartMate 3 LVADs?

Comparison

Pharmacogenetic testing plus pharmacist-led warfarin management vs usual care supervised by physicians

Design

Single-center prospective randomized controlled unblinded study

Follow-up

12 weeks

Key result

Pharmacist-led warfarin management with pharmacogenetic testing significantly increased time in therapeutic range compared with physician-led usual care (78.1% vs 67.1%; P<0.05).

Authors

SGS. GregorDMDušan MertaPIPeter Ivak

Discussion

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Overview

May support pharmacist-led warfarin management in LVAD patients; leaves open need for larger trials on clinical outcomes.

Key Points

  • The aim was to assess whether pharmacist-led anticoagulation management using pharmacogenetic testing improves time in therapeutic range for LVAD patients on warfarin.
  • Single-center, prospective, randomized, controlled, and unblinded study.
  • Patients randomized into intervention group (pharmacogenetic testing and pharmacist management) or control group (physician management).
  • Pharmacogenetic screening conducted for CYP2C9*2, CYP2C9*3, and VKORC1 before warfarin initiation.
  • Time in therapeutic range was 78.1% for the intervention group compared to 67.1% for the control group (P < 0.05).
  • Eighteen patients in the intervention group and 23 in the control group completed the study.
  • Baseline characteristics were similar between the two groups.

Study Design

Type

RCT (n=48)

Blinding

Unblinded

Randomization

randomized

Multicenter

No

Structured PICO

Does pharmacist-led warfarin management using pharmacogenetic testing improve time in therapeutic range in patients with HeartMate 3 LVADs?

P
Population
48 patients supported with a left ventricular assist device (HeartMate 3) requiring warfarin anticoagulation, followed for 12 weeks.
I
Intervention
Pharmacogenetic screening (CYP2C9*2, CYP2C9*3, and VKORC1) before warfarin initiation combined with anticoagulation management led by clinical pharmacists
C
Comparator
Usual care (warfarin dosing and overall anticoagulation management supervised by physicians, with genetic testing results kept blinded)
O
Outcome
Time in therapeutic range (TTR) within 12 weeks following warfarin initiationsurrogate

Main Result

Absolute Event Rate: 78.1% vs 67.1%

p-value: p=<0.05

Pharmacist-led warfarin dosing guided by pharmacogenetic testing significantly improves time in therapeutic range compared to physician-led usual care in patients with HeartMate 3 LVADs.

Cite This Study

Gregor et al. (2026) conducted an RCT in Left ventricular assist device (LVAD) HeartMate 3 (n=48). Pharmacist-led warfarin management with pharmacogenetic testing vs. Physician-led usual care was evaluated on Time in therapeutic range (TTR) within 12 weeks following warfarin initiation (p=<0.05). Pharmacist-led warfarin management with pharmacogenetic testing significantly increased time in therapeutic range compared with physician-led usual care (78.1% vs 67.1%; P<0.05).

synapsesocial.com/papers/6a53302d4f7abc118aded2bahttps://doi.org/10.1177/10600280261458912
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