Alright, so I just found out that I posted a spam bot post. Not from a nice student named Ashley.
Instead what I will post is a subgroup analysis of TRITON TIMI 38. The subgroup analysis? 2C19 PMs and Prasugrel.
Great clinical question-Did the PMs (poor metabolizers) on Prasugrel fare better than the PMs on Plavix.
The obvious answer:
Duh, of course yes.
But Always we need some science and statistics here.
Individuals with a CYP2C19 reduced-metabolizer genotype were estimated to have a substantial reduction in the risk of the composite primary outcome (cardiovascular death, myocardial infarction or stroke) with prasugrel compared to clopidogrel (relative risk 0.57; 95% confidence interval [CI], 0.39 to 0.83).
Ok, so we should screen for PMs? Probably.
What about every other result?
What about the EMs?
For CYP2C19 extensive-metabolizers (EM) ( approximately 70% of the population), however, the composite outcome risks with prasugrel and clopidogrel were not substantially different (relative risk 0.98; 95% CI, 0.80 to 1.20).
The Sherpa Says: We should AT LEAST be identifying the PMs and placing them on Prasugrel. This subgroup analysis shows increased risk while on Plavix. Primum Non Nocere.
Recommendation and review posted by G. Smith
