CardioExchange Archive

March 28th, 2011

Updated Unstable Angina/Non-STEMI Guidelines Released by ACC & AHA

Larry Husten, PHD

The AHA and ACC have released a focused update of the 2007 guidelines for the management of unstable angina and non-STEMI. The guidelines incorporate new information from recent clinical trials, and deal with controversial topics such as the choice of antiplatelet agents, the use of platelet-function and genetic tests with antiplatelet agents, and the timing […]

---

March 15th, 2011

GRAVITAS Editorial: Why Invite the Fox into the Henhouse?

Richard A. Lange, MD, MBA and L. David Hillis, MD

Results from the GRAVITAS randomized trial, presented at the 2010 American Heart Association conference, have just been published in JAMA. They show that high-dose clopidogrel did not improve outcomes after percutaneous coronary intervention (PCI) in patients with “high on-treatment platelet reactivity” (i.e., during clopidogrel therapy), compared with clopidogrel given at conventional doses. Our interpretation at CardioExchange, reported at […]

---

February 27th, 2011

Examining an Ad for a Platelet-Inhibition Test

Harlan M. Krumholz, MD, SM

I’ve recently seen in medical journals an advertisement that features an image of a clot within a stent and this headline in all capital letters: “Low Levels of Platelet Inhibition May Have Significant Consequences.” The final two words, “Significant Consequences,” are in a very large font, and the entire ad has an ominous black background. Below […]

---

February 18th, 2011

A Case of Clopidogrel Nonresponsiveness?

Tariq Ahmad, MD, MPH and James Fang, MD

This latest installment in our case discussion series is submitted by Tariq Ahmad, MD, MPH. We encourage members to submit cases that they believe warrant discussion. Selected cases will be presented to the community, and case authors will receive a $100 Amazon gift card. A 70-year-old woman presents to the ED with an anterior STEMI. She […]

---

November 16th, 2010

GRAVITAS: No Benefit for Clopidogrel Dosing Based on Platelet Function Test

Larry Husten, PHD

The GRAVITAS (Gauging Responsiveness With A VerifyNow Assay ─ Impact on Thrombosis and Safety) trial enrolled 2214 patients with high residual platelet reactivity, as assessed by the VerifyNow P2Y12 Test measured 12 to 24 hours after the procedure. (The manufacturer of the test, Accumetrics, sponsored the trial.) Patients in the trial were randomized to either high-dose clopidogrel […]

---

November 9th, 2010

Statement from AHA, ACC, and ACG Reaffirms Use of PPIs with Antiplatelet Therapy

Larry Husten, PHD

Despite recent warnings by the FDA, an expert consensus document released jointly by the AHA, the ACC, and the American College of Gastroenterology states that it is acceptable to use proton pump inhibitors (PPIs) with thienopyridines like clopidogrel in patients at high risk for upper GI bleeds. The statement does not recommend routine use of […]

---

November 8th, 2010

Up-Front Clopidogrel Loading Versus Common Sense

John E Brush, MD

From time to time, a sales representative visits my office promoting clopidogrel (Plavix) as a drug that patients who present with unstable angina/non–ST-segment-elevation MI (UA/NSTEMI) should start immediately as an up-front load. That strategy hasn’t been uniformly accepted in my clinician community because of concern about using an irreversible antiplatelet agent to treat patients who […]

---

November 4th, 2010

Clopidogrel and CYP2C19: What’s All the Fuss About?

Richard A. Lange, MD, MBA and L. David Hillis, MD

You’ve heard a lot lately about so-called “clopidogrel resistance.” That sounds straightforward, but the underlying reason can be complex, possibly related to how the drug is metabolized by subjects with a certain genetic profile. We seek here to provide some perspective about clopidogrel’s metabolic and gene-related complexities. First, some brief background: Clopidogrel, a thienopyridine, is a […]

---

November 3rd, 2010

Do Your Patients Wait to Fill Their Plavix and Effient Prescriptions After Drug-Eluting Stent Implantation?

Chris Smith, RN

I recently read an article in the journal Circulation that contained an alarming finding about patients who receive drug-eluting stents. Apparently, 1 in 6 did not fill their clopidogrel prescriptions immediately after discharge from a hospital in one of three large integrated health care systems. The median delay was 3 days. Furthermore, during a median follow-up […]

---

October 27th, 2010

Meta-Analysis Examines Risk Associated with CYP2C19 Genotypes

Larry Husten, PHD

There has been widespread debate and disagreement over the clinical significance of people with reduced function CYP2C19 genotypes who take clopidogrel. In an effort to shed light on the topic, Jessica Mega and colleagues analyzed data from 9685 patients enrolled in nine clinical trials. Some 26% of patients had 1 reduced-function allele, and 2% had […]

---