I am surprised to see Scripts making this sweeping change regarding post stent treatment without the benefit of a controlled tiral showing value.  I am surprised and pleased. 

 It seems to me that rational thought has largely been abandoned by the medical "thought leaders" with their need for massive controlled tirals prior to initiation of a new technology.  Considering the bad outcomes associated with this genetic marker, proactive intervention seems to make sense.  I am curious if the starched collars from the east coast will agree.

Eric, I am interested in whether you will match your hematologic data with available bedside monitoring devices. As we know thromboelastography is the gold standard but not a bedside tool. TEG and VerifyNow have yet to be trialed in the large PCI population and are at least relatively unproven but provide reasonable rapid assessment of platelet function.

Look forward to seeing the registry data as well as how Scripps handles the asymptomatic non/low responder.

WSS

Yes, I aggree with William above.  I am a hematologist, and I recently reviewed this topic for a lecture I gave on genetic profiling in individualized drug dosing.  The randomized trials fail to show a benefit for genotyping Plavix, so I wonder whether you plan to give us a rationale for your current testing strategy.

Regards,

InteractMD.com

Plavix is a mutimillions dollars bussiness. Anyone talking about anti-platletsaggregation should  first make it clear in the first line - not at the bottom- that they have no finantial connection even indirectly with the Plavix empire.

giorgioMD

Eric,

 I am surprised that you recommend this now without randomized trials. This is observational data. The recent trial presented at  TCT (randomized COGENT trial) showed that the concern from observational data about the negative interaction of PPIs and plavix appear to be unfounded- there is a disconnect between lab data and clinical outcome.

You may be right, but hate to change practice before the data is in.

Please see the article posted on theheart.org Oct 14th to respond to the queries and crtique

Thanks for writing!