Part of my thesis work was focused on developing a clinically useful PKPD-based pharmacometric model in NONMEM that describes the relationship between warfarin dose and INR response. The model was developed on longitudinal data from warfarin treated adults and extended to children through the use of physiological principles. To aid clinical use, the NONOMEM model has been transferred to a user-friendly, Java-based tool. The tool can be used to manage a priori dose prediction and a posteriori dose revision of warfarin therapy for both adults and children.
This type of mechanism-based decision support tools could ensure more consistent dose adjustment practices between prescribers, and provide the necessary support for efficient and more personalised warfarin dosing in both children and adults.

 

 Example of a priori estimation of a stable maintenance dose 

Example of a priori estimation of a stable maintenance dose 

 Example of a personalised (a posteriori) dose estimation 

Example of a personalised (a posteriori) dose estimation