NEW YORK (EGMN) – Findings in 10 key investigative areas, from platelet inhibition and left main coronary artery disease to the use of fractional flow reserves and the "kissing" stent could have a profound impact on interventional cardiology in the next year or so.
Dr. Samin K. Sharma, co-director of the Cardiovascular Institute at Mt. Sinai Medical Center in New York, provided his take on these findings at the Mt. Sinai Live Symposium of Complex Coronary and Vascular Cases.
They are as follows:
Clopidogrel resistance and proton pump inhibitor (PPI) interaction studies.
In March, the FDA issued a warning that clopidogrel, widely prescribed to patients who have had a heart attack or stroke, is not as effective in people who cannot metabolize the drug. Dr. Sharma cited numerous reports that have shown that PPI drugs inhibit the activity of clopidogrel. In the clinic, physicians can test patients for platelet inhibition and use that data accordingly to modify dosing of the PPI.
"Avoid routine use of PPI with clopidogrel," Dr. Sharma said. "If proton pump inhibition is needed, use H2 receptor blockers instead. If you need to use a PPI, many studies have shown it to be safer to use clopidogrel in the morning and the PPI in evening." In high-risk patients, he advised using a 600-mg loading dose of PPI, then 150 mg daily. While genetic testing may help identify vulnerable groups, he added, it's "a very complex issue cost wise."
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