A genetic test could help cut down the chances of getting another stroke for patients with the CYP2C19 gene variant by preventing doctors from giving them an ineffective medication. — PA Wire/dpa
People who suffer the most common type of stroke should be given a genetic test to find out which drugs can prevent future attacks, a British watchdog has said.
The UK National Institute for Health and Care Excellence (Nice) said people who have had an ischaemic stroke – where a clot blocks the flow of blood and oxygen to the brain – or a transient ischaemic attack (TIA) should be tested.
In new draft guidance, the watchdog said doctors who are considering giving the drug clopidogrel should first reach for the genetic test.
Clopidogrel is a common drug which prevents platelets – a type of blood cell – from sticking together and forming a dangerous blood clot.
Nice currently recommends clopidogrel as an option for treating people at risk of having another stroke, but it is not suitable for people with certain variations in a gene called CYP2C19 because they cannot convert the drug properly for use in the body.
The genetic test would help overcome this by finding people with these variants so that they can be treated with an alternative drug.
Some 32% of people in the United Kingdom are thought to have at least one of the CYP2C19 gene variants.
Evidence has suggested that these people have about a 46% increased risk of another stroke when taking clopidogrel, compared to those without the variants.
If laboratory testing – estimated to cost around GBP139 (RM795.76) per test – is not possible, Nice said the Genomadix Cube test costing GBP197 (RM1,127.81) and given at the bedside, can be used instead.
There are around 100,000 strokes every year in the UK, of which around 43,000 are recurrent strokes.
Every year, 46,000 people in the UK have a TIA for the first time, which is seen as a warning that they are at risk of stroke.
Nice medical technology and digital evaluation interim director Mark Chapman said: "The recommendation is a step forward in ensuring people who have had a stroke receive personalised care, thanks to a genetic test run after their DNA is sequenced using their blood or saliva.
"Treatment with clopidogrel is effective in preventing further strokes for the majority of people who don’t have the gene variant.
"But until now, doctors have not known who cannot be treated with clopidogrel until after they’ve had a second stroke or TIA, and that could be too late.
"If the CYP2C19 variants are found, other treatment options can be used.
"This test ensures we’re getting the best care to people quickly, while at the same time ensuring value for money for the taxpayer.”
Around 11 million items of clopidogrel are dispensed each year at a cost of around GBP16 million (RM92 million) to the UK National Health Service (NHS), Nice said.
The draft guideline is subject to consultation. – PA Media/dpa
