“The scientist is not a person who gives the right answers; he's one who asks the right questions,” French anthropologist Claude Lévi-Strauss once said. While medicine involves solving complex cases with new technologies and therapies, it often fuels questions, particularly when the risks of a procedure or treatment may outweigh the benefit.
Recently, research has shown that the use of clopidogrel may be ineffective in curbing bleeding events after PCI in patients who carry loss-of-function alleles. Because this could be problematic for 2 to 14 percent of the population, researchers are beginning to ask: How can we tailor pharmacodynamic patient responses to drugs?
In this week’s news, researchers from Brigham and Women’s Hospital and Harvard Medical School in Boston, found that patients who carry the CYP2C19 loss-of-function allele are also at a heightened risk for cardiovascular events.
In fact, carriers of one or two reduced-function alleles are at a higher risk for stent thrombosis.
These findings bolster the need to study gene expression or alternative therapies in this population of patients.
Similarly, a study published in the New England Journal of Medicine found that weekly self-testing to maintain warfarin anticoagulation in patients with mechanical heart valves or atrial fibrillation may be a viable option, particularly for those in geographic distance from a clinic-based approach to care.
Self-testing may not be for everyone, as the costs were almost $1,300 higher for these patients. But researchers showed that self-testing is indeed a safe option for those who may not be able to make frequent visits to a clinic.
Meanwhile, a JACC study showed that same-day discharge after uncomplicated transradial PCI, in addition to a bolus-only abciximab regimen, decreased healthcare related costs by nearly 50 percent. This approach saved almost $1,200 and decreased the length of stay by almost 20 hours.
In 2006, the number of hospitalizations for coronary artery disease reached 1.2 million and costs are soaring; however, a push to discharge patients after elective, uncomplicated PCI procedures could significantly reduce healthcare costs.
The advantage of medicine is that it is not set in stone. Nearly every treatment option is offered with an alternative treatment, therapy or approach, leaving room for better care and sometimes even a strategy for cutting costs. Researchers continually offer healthcare solutions, but more importantly, they continue to ask probing questions.
Are you testing PCI patients for genetic variants? How have you empowered patients to engage in home-centered care? Have you increased your transradial approaches? On these or other topics, please feel free to contribute to the dialogue.