for the non chemists titration here means determining by analysis. AKA INR measurement. This is exactly what I bang on about here ... for those who don't need any dose adjustment, good luck to you, I wish I was like that (but then, thinking like a Stoic I would not have learned as much)Effective management of patients with unstable INR requires frequent in-clinic testing and dose titration.
by lack of evidence I expect they mean "we've looked real hard to find support of using this and found repeatably that it can't be relied on and thus measurement is the gold standard for getting into the therapeutic window."Because of the lack of good-quality evidence, pharmacogenetic testing cannot be recommended to guide the dosing of VKAs.