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Antiplatelet therapy: A step forward with individualized medicine
Posted Sep 22, 2009
at 10:30 AM, EDT
by Eric Topol
The Scripps clinic and health system is announcing at TCT this week routine genotyping of all patients undergoing stenting after concluding that this data is vital in selecting antiplatelet therapy. What are your thoughts? How do you follow patients who take clopidogrel and have shown a potential increased risk for stent thrombosis or other events?
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Eric J Topol MD
Director, Scripps Translational Science Institute The Gary and Mary West Chair of Innovative Medicine Chief Academic Officer, Scripps Health La Jolla, CA |
CommentsCommentaires
I am surprised to see Scripts making this sweeping change regarding post stent treatment without the benefit of a controlled tiral showing value. I am surprised and pleased.
It seems to me that rational thought has largely been abandoned by the medical "thought leaders" with their need for massive controlled tirals prior to initiation of a new technology. Considering the bad outcomes associated with this genetic marker, proactive intervention seems to make sense. I am curious if the starched collars from the east coast will agree.
Eric, I am interested in whether you will match your hematologic data with available bedside monitoring devices. As we know thromboelastography is the gold standard but not a bedside tool. TEG and VerifyNow have yet to be trialed in the large PCI population and are at least relatively unproven but provide reasonable rapid assessment of platelet function.
Look forward to seeing the registry data as well as how Scripps handles the asymptomatic non/low responder.
WSS
Yes, I aggree with William above. I am a hematologist, and I recently reviewed this topic for a lecture I gave on genetic profiling in individualized drug dosing. The randomized trials fail to show a benefit for genotyping Plavix, so I wonder whether you plan to give us a rationale for your current testing strategy.
Regards,
InteractMD.com
Plavix is a mutimillions dollars bussiness. Anyone talking about anti-platletsaggregation should first make it clear in the first line - not at the bottom- that they have no finantial connection even indirectly with the Plavix empire.
giorgioMD
Eric,
I am surprised that you recommend this now without randomized trials. This is observational data. The recent trial presented at TCT (randomized COGENT trial) showed that the concern from observational data about the negative interaction of PPIs and plavix appear to be unfounded- there is a disconnect between lab data and clinical outcome.
You may be right, but hate to change practice before the data is in.