Presence of the CYP2C19

themedco — Mon, 01 Feb 2010 01:30:35 +0000

Presence of the CYP2C19*17 genetic variant is significantly associated with enhanced response to clopidogrel and an increased risk of bleeding— with no observed increase in efficacy (ischemic outcomes). There was also an increase in response to clopidogrel as measured by platelet aggregation assays. Forpatients with a homozygous *17 variant, there was approximately a 4X increase in bleeding risk. Although the lack of impact of this increased platelet inhibition on ischemic endpoints could be one of power, the authors speculate that in these patients increased platelet inhibition with clopidogrel could be detrimental because of the risks associated with bleeding. Also not known is whether the observed effect of higher response to clopidogrel (more bleeding but no more efficacy) would translate in any way to other drugs. Recent trials including other thienopyridines (prasugrel) and non-thienopyridine drugs (ticagrelor, cangrelor).

Blood Pressure Control

themedco — Mon, 01 Feb 2010 01:29:16 +0000

Area under the curve: a new metric to assess BP management. In a short communication, Drs Chen, Sherman, Dyke and Aronson propose a new tool for evaluating the impact of antihypertensive medications “…anoptimal target range may exist for perioperative control of BP in cardiac surgical patients that includes both a level and duration of hemodynamic instability. The AUC is a new metric to assess the precisions of blood pressure management. A lack of consideration for this comprehensive measure may account for the conflicting outcomes of prior randomized trials that only compared high vs low mean arterial pressures during CABG”

To be continued…

Cleviprex blog

Presence of the CYP2C19

Blood Pressure Control