Please select the eligibility criteria that correspond to the clinical trial below.
Title: The Clinical Impact of Applying Pharmacogenetic Algorithms to Individualize Dosing of Warfarin in Patients Being Initiated on Oral Anticoagulation
Brief Summary: The purpose of this study is to determine whether DNA analysis improves the efficiency of dosing and safety in patients who are being started on warfarin therapy.Warfarin, a blood thinner (anticoagulant) prescribed to 1-2 million patients in the United States, is a leading cause of drug-related adverse events (e.g., severe bleeding), in large part due to dramatic (20-fold) differences between individuals in dose requirements. At least half of this variability now can be explained by 3 common genetic variants, age, body size, and sex; however, warfarin therapy continues to begin with the same dose in every patient with the correct individual dose determined by trial and error. This study proposes to determine genetic variations the same day from DNA simply obtained by swabbing the inside of the cheek and use this information to determine the proper dose regimen individually in each patient. The aim is to show that the investigators can achieve more rapid, efficient, and safe dosing in up to 500-1000 individuals who are initiating warfarin therapy for various clotting disorders across a large healthcare system in order to demonstrate improved dosing effectiveness, efficiency, and safety with genetic-based dosing, which could lead to a nationwide application resulting in as much as a $1 billion dollar annual benefit in healthcare outcomes.


Options:
A: Inclusion Criteria:

* New participants will be those \>=18 years old who are appropriate candidates for and being initiated on warfarin therapy with target international normalized prothrombin time ratio (INR) range of either 2-3 or 2.5-3.5 and with intent to be treated for at least 1 month and willing to sign informed consent.
* Those with target INR 2.5-3.5 may be enrolled with dose adjustment for this higher target per Gage et-al. (i.e., 11% increase in dose).
* Dose modification also will be made for amiodarone based on prior, published experience (i.e., 22% decrease in dose).

Exclusion Criteria:

* Those not appropriate for warfarin (e.g., pregnancy) or for pharmacogenetic (PG)-guided dosing for any reason,
* Those having received rifampin within 3 weeks,
* Those with severe co-morbidities (e.g., creatinine \> 2.5,hepatic insufficiency, active malignancy, advanced physiological age, noncompliance risk, expected survival \<6 months), and
* Physician or patient preference.
B: Inclusion Criteria:

* Age between 25-39 years
* First stimulation with rFSH only
* Indication for intrauterine insemination with standard rFSH starting dose
* Regular menstrual bleeding with a cycle between 21-35 days
* Two ovaries
* Bilateral tuba patency
* Semen analysis must be sufficient for insemination according to the diagnostic analysis.

Exclusion Criteria:

* More than three former stimulated intrauterine insemination cycles
C: Inclusion Criteria:

* prescriber at the study facility

Exclusion Criteria:

* not a prescriber at the study facility
D: Inclusion Criteria:

* Consecutive inpatients of the internal medicine and the orthopedic surgery department of the Cantonal Hospital of St. Gallen needing new onset oral anticoagulation

Exclusion Criteria:

* Patients with prior oral anticoagulation with coumarines within less than 6 weeks,
* patents, who received vitamin-K supplements within less than one week before the onset of oral anticoagulation,
* patients with liver cirrhosis other than Child A,
* pregnant women (pregnancy has to be excluded in women of childbearing age),
* patients younger than 18 years, and
* patients unwilling or unable to give informed consent
* patients with (clinically diagnosed) dementia and
* persons with insufficient German, French, Italian or English language skills)

Answer: A