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Several factors lead to warfarin dose variability, including genetic and non-genetic factors which made warfarin management challenging especially at the initiation phase. To overcome the challenges with warfarin dosing at initiation, strategies other than conventional or fixed dosing were introduced and explored. <jats:italic>Aim<\/jats:italic> In this narrative review, we aim to discuss and critique the different dosing strategies for warfarin at initiation with more focus on genotype-guided warfarin dosing and the most recent supporting evidence for and against its use. <jats:italic>Method<\/jats:italic> Medline database was searched from 1965 to July 2021. Articles addressing different warfarin dosing methods were screened for inclusion. <jats:italic>Results<\/jats:italic> A number of methods exist for warfarin initiation. Studies comparing different dosing methods for initiation yielded conflicting outcomes due to differences in study design, population studied, comparator, and outcomes measured. <jats:italic>Conclusions<\/jats:italic> Looking at the big picture, the use of genetic dosing for warfarin initiation can lead to better outcomes. Whether these better outcomes are clinically or economically beneficial remains controversial.<\/jats:p>","DOI":"10.1007\/s11096-022-01386-8","type":"journal-article","created":{"date-parts":[[2022,3,5]],"date-time":"2022-03-05T07:02:48Z","timestamp":1646463768000},"page":"599-607","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Warfarin dosing strategies evolution and its progress in the era of precision medicine, a narrative review"],"prefix":"10.1007","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1502-6700","authenticated-orcid":false,"given":"Amr Mohamed","family":"Fahmi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1594-1199","authenticated-orcid":false,"given":"Hazem","family":"Elewa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6387-5419","authenticated-orcid":false,"given":"Islam","family":"El Jilany","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,3,5]]},"reference":[{"key":"1386_CR1","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1002\/phar.2350","volume":"40","author":"S Perreault","year":"2020","unstructured":"Perreault S, de Denus S, White-Guay B, et al. 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