Private practice with Dr Seth Bilazarian

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GRAVITAS has immediate impact on my practice

Nov 19, 2010 12:05 EST


I was an early and enthusiastic adopter of the VerifyNow test and the strategy of increasing the dose of clopidogrel in patients with high residual platelet-reactivity scores. Following the GRAVITAS results announced at AHA 2010, my use of point-of-care testing for platelet reactivity will grind to a halt.

Are you surprised by GRAVITAS? Have you been using point-of-care tests for platelet reactivity? How will GRAVITAS change your practice?

See:

GRAVITAS: No benefit of doubling dose in clopidogrel nonresponders

VerifyNow platelet test: Should we all be using it?





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Your comments
GRAVITAS has immediate impact on my practice
# 1 of 2
December 13, 2010 12:49 (EST)
Mehrdad Saririan

Seth, why "VerifyNotNow"? You still have the option to switch to prasugrel for non-responders, as opposed to the double dose clopidogrel, which per GRAVITAS doesn't work. GRAVITAS was not a failure of the test, but a failure of double dose clopidogrel. 

 

 
# 2 of 2
December 24, 2010 03:49 (EST)
Seth Bilazarian

Mehrdad, Thanks for your comment.  I think that the predictive value of this test for outcomes remains useful but the logical strategy of intensifying therapy with clopidogrel in non reponders failed to show a benefit (or even a trend)  so until there is evidence mking the next "logical " step of intensifying therapy with a more potent thienopyridine like prasugrel has to be dealt with a greater degree of circumspection until there is proof.  Because of that I think the utility of the test for improving outcomes is absent without evidence and therefore the Verify Not Now.

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About Dr Seth Bilazarian
Seth Bilazarian MD has been a Clinical and Interventional Cardiologist at Pentucket Medical Associates in Massachusetts since 1993. He is board certified in Internal Medicine, Cardiovascular Medicine, Nuclear Cardiology, Vascular Ultrasound, Interventional Cardiology, and Vascular and Endovascular Medicine.

Dr Bilazarian performs coronary and peripheral interventions at Lahey Clinic and Massachusetts General Hospital. He has been an investigator in the interventional laboratory for new devices including drug-eluting stents, distal protection devices, imaging devices (OCT and InfraRed), and anticoagulant pharmacotherapy.

Dr Bilazarian is an active participant in clinical trials in congestive heart failure, hypertension, coronary disease prevention, prediabetes management, anemia, atrial fibrillation, and anticoagulation/antiplatelet therapies in the outpatient setting. He has authored numerous papers and book chapters in clinical cardiology. He was appointed as a physician advisor to the circulatory device panel of the FDA in 2008.
About this blog
My intent is to create a forum for dialogue on issues pertinent to private practice cardiology around topics such as:

  • Integration of new data and guidelines on inpatient and outpatient practice in clinical and interventional cardiology
  • Practice approaches to the extra clinical issues in dealing with managed care insurers
  • Strategies for navigating the restrictions of pharmacy benefits managers (PBMs) on pharmacologic therapies for our patients
  • Experiences with restrictions on testing and imaging
The video blog (VLOG) will provide an opportunity to share broadly different approaches to the common conundrums we face in caring for patients. My hope is that this forum will provide useful data points for practice outside of tertiary and academic centers and a look inside community hospitals and physician?s practice patterns in the office, starting with mine.