Precision Pharmacy in Hematology: Integration of Pharmacogenomics into Clinical Decision-Making in Anticoagulant and Chemotherapeutic Agents

Background: Precision pharmacy, driven by pharmacogenomics, personalizes anticoagulant and chemotherapeutic therapy based on the genetic profile of the patient, which enhances the outcome of therapy in hematologic diseases. Aim: This review attempts to address the integration of pharmacogenomics into decision-making regarding anticoagulants and chemotherapeutics in hematology with special reference to the pharmacist. Methods: Systematic review of literature using PubMed, Scopus, and Web of Science was conducted for studies between the years 2020-2024. Selection criteria focused on pharmacogenomic applications in hematology. Data were integrated to identify key gene-drug interactions, implementation strategies in clinics, and hindrances. Results: Pharmacogenomic testing of CYP2C9/VKORC1 for warfarin dosing reduced bleeding events by 15%, while TPMT/NUDT15 testing for thiopurines reduced myelosuppression by 25%. Clinical decision support systems (CDSS) and proactive testing, like the PHASER program, improved outcomes by 12–18%. Limitations involve cost, availability, and clinician training constraints. Conclusion: Pharmacogenomics improves the safety and efficacy of anticoagulant and chemotherapeutic treatment in hematology, with pharmacists as central implementers. Continued advances in AI and multi-omics will progressively optimize precision pharmacy.