Alright, so I just found out that I posted a spam bot post. Not from a nice student named Ashley.
Instead what I will post is a subgroup analysis of TRITON TIMI 38. The subgroup analysis? 2C19 PMs and Prasugrel.
Great clinical question-Did the PMs (poor metabolizers) on Prasugrel fare better than the PMs on Plavix.
The obvious answer:
Duh, of course yes.
But Always we need some science and statistics here.
Individuals with a CYP2C19 reduced-metabolizer genotype were estimated to have a substantial reduction in the risk of the composite primary outcome (cardiovascular death, myocardial infarction or stroke) with prasugrel compared to clopidogrel (relative risk 0.57; 95% confidence interval [CI], 0.39 to 0.83).
Ok, so we should screen for PMs? Probably.
What about every other result?
What about the EMs?
For CYP2C19 extensive-metabolizers (EM) ( approximately 70% of the population), however, the composite outcome risks with prasugrel and clopidogrel were not substantially different (relative risk 0.98; 95% CI, 0.80 to 1.20).
The Sherpa Says: We should AT LEAST be identifying the PMs and placing them on Prasugrel. This subgroup analysis shows increased risk while on Plavix. Primum Non Nocere.