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Patient genotypes guide drug therapy in new VU program

By Bill Snyder
January 2011

All patients undergoing cardiac catheterization at Vanderbilt University Medical Center are being tested for a genetic variation that can affect their response to a blood-thinner many of them will end up taking.

The new program, which launched Sept. 15, 2010, is called PREDICT, for Pharmacogenomic Resource for Enhanced Decisions in Care and Treatment.

The genetic information will be placed in their electronic medical records to help their physicians choose the drug and dose that is best for them. Having the information there means it's immediately available to doctors when the drug is prescribed, not hours or days later.

The goal is to reduce the risk of future complications, including strokes, heart attacks and sudden cardiac death.

Vanderbilt is the first academic medical center in the country to deliver this form of “decision-supported, personalized” drug therapy. It was developed by a team of experts led by Dan Roden, M.D., assistant vice chancellor for Personalized Medicine; Dan Masys, M.D., chair of Biomedical Informatics; Jim Jirjis, M.D., MBA, chief medical information officer; and Jill Pulley, MBA, assistant professor of Medical Education and Administration.

Every year, 4,000 patients at Vanderbilt undergo cardiac catheterization because of suspected heart disease. The X-ray test can detect “narrowings” in the coronary arteries that threaten to cut off the heart's blood supply.

In about 1,700 patients, tiny tubes called stents will be placed in narrowed arteries to keep them open, and the patients will be given the anti-coagulant drug Plavix to prevent clots from forming around the stent.

The problem is, about 1,000 of the patients will carry a genetic variation that prevents Plavix from being efficiently converted in the liver into its active form.

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