The first step in personalized medicine?
Warfarin, sold under the brand name Coumadin and in generic forms, yesterday became the first widely used drug to include genetic testing information on its label. The information can help doctors determine how best to prescribe the drug.“This means personalized medicine is no longer an abstract concept but has moved into the mainstream,” the Food and Drug Administration’s clinical pharmacology chief, Larry Lesko, said in disclosing the label change.
Dr. Wes is skeptical.
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Of course the only reason we need this test is because patients are being discharged much quicker than in the past.
Anticoagulating patients back in my internship days meant daily or twice daily monitoring of the coagulation status, and determining the pharmacokinetics and pharmacodynamics on the fly. You don’t need a genetic test to predict the response if you are adequately and in a timely manner measuring the response.
No reason as a doc to recoil at this new reccomendation. It helps with the realities of modern practice where I cannot keep the patient until the coags are stable. The DVT with PE now gets you 2 days stay only.
Why is the genetic test better than checking INR’s? I don’t get it.
Check it once. Check an INR every week to two once stable. It only gives us a better starting point. The due diligence is still required to monitor patients. But at least you won’t get the first month horror stories. You still need INRs, God I hope that “genomically inept” MDs won’t assume they don’t need INRs!!! This test and the dosing adjustment is only a stepping off point for personalized medicine. We still need to practice medicine, but this time smarter.
-Steve
http://www.thegenesherpa.blogspot.com
http://www.helixhealth.org
“genomically inept MD’s”???
What the f&%^ are you talking about???
Anyway, the majority of INR check occur in a hospitalized setting, as these aptients usually need lovenox or UFH as well. And the follow ups are also typically more frequent as they are given a lot of follow ups after discharge. Also, coumadin clinics exist just for this sort of thing.
ClotCare provides a thorough examination of this issue at:
http://www.clotcare.com/clotcare/warfaringenetictesting.aspx
Coumadin Test http://www.pgxhealth.com
they help with reimbursement.
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