Private practice with Dr Seth Bilazarian

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VerifyNow platelet test: Should we all be using it?

Dec 2, 2009 16:20 EST


An omnipresent possibility, platelet resistance is being studied more closely as witnessed by the POPULAR study published during AHA. New tests such as "VerifyNow" offer us onsite methods to screen for resistance, while double-dosing of clopidogrelas shown in OASIS-7—and the approval of prasugrel have expanded our therapeutic options.

While we wait for definitive answers from the GRAVITAS study, how are you managing the risk of platelet resistance in your practice?

VerifyNow is a point of care test available for office or laboratory use and reimbursed by payers.

See:

POPULARity contest: For platelet function assays, what works, what doesn't

CURRENT OASIS-7: Benefit to doubling clopidogrel dose in ACS patients undergoing PCI

Scripps starts routine genetic testing for clopidogrel responsiveness








Your comments
VerifyNow platelet test: Should we all be using it?
# 1 of 3
February 10, 2010 11:39 (EST)
Frederick Yturralde
Clopidogrel responsiveness is interesting w/regards to therapy manipulation, although backed by limited data, as you have shown. In my practice, in Florida, I have patients that are older and have more complex CAD then what I experienced while a fellow in Boston. My average age of STEMI pt's is 5-10 years older and a greater proportion are low BMI women. Hence, bleeding is a significant concern. I am curious if there is any data about the ability to lower the doses or frequency of duration of clopidogrel, etc. after PCI?
# 2 of 3
June 26, 2010 12:41 (EDT)
Damras

What's about Multiplate analyzer.

Our lab acquires this test for clopidogrel - ADP platelet reactivity test. 

# 3 of 3
August 11, 2010 01:37 (EDT)
Seth Bilazarian

Fred,

There is no data on the Verify Now for bleeding risk at this time.  The PRU < 235 is predictive of higher thrombotic events.  The genetic markers may be able to distinguish the patietns at greater bleeding risk, but for now we dont have anything we can rely on in clinical practice.


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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.