Friday, October 9, 2009

Ok, Fine, Back to Plavix

Did anyone else see this?

Scripps and Eric Topol are going to be doing testing for 2C19 polymorphisms in their interventional dept.

"Scripps physicians will initially offer the genetic tests to elective stent patients before they undergo their procedures at Scripps Green Hospital. Eventually, Scripps may extend the offering to its other facilities across San Diego County."

I have been prodding Greenwich Hospital to do this.....I hope they do......They could be the El Camino of the East.

What are these guys, Topol going to be doing?
"Scripps patients carrying the gene risk variants will be considered for three treatment choices following their stent procedures, each on an individualized basis. Patients will either:

  • Be given a routine 75 milligram dose of Plavix with careful surveillance;
  • Be given a 150 milligram dose of Plavix, which has recently been shown to be safe and effective in patients showing lack of response to Plavix; or
  • Be given the newly approved medicine Effient (prasugrel), which is not affected by the gene variant Cytochrome (CYP) 2C19."
So there you have it. A cutting edge medical facility doing this. I am only all too certain we will see about 20 hospitals follow in their footsteps in 2010.....

The Sherpa Says: Wha? These guys are like a year behind me......I have been doing this since January........


Big Bad Bob said...

Steve- I'm not seeing your reference for this post. Can you re-post it?


Andrew said...

Why not simply use prasugrel first and order no genetic test? I think generic "Plavix" is coming in 2011, but my instinct is that the operational complexity of monitoring clopidogrel efficacy ---especially when combined with genetic testing--- is much more expensive than the cost difference between the two drugs.

Andrew said...

Like: "Start patient on prasugrel to solve their problem first. Then, if you have time, optimize and consider clopidogrel later, but in the meantime, the problem is solved while preserving the most limited resources: physician attention and patient health.

Red Herring said...

But if you do this test and 150 or 1500 or 15,000 others like it for pennies when they enter your practice 12 years before they need these pharmaceuticals, then using the data to make wise clinical judgments becomes second nature and not some intellectual and logistical cirque du soleil. This is one of the baby steps we must take to get to that place. Did I get that vision of PM right, Steve?

Steve Murphy MD said...