June 13, 2015 | Harrison | Leave a comment Facebook Twitter LinkedInCarol, 63 Orange, CA Symptoms: · Unsightly bruising · Excessive bleeding Clinical Analysis: An anti-platelet therapy was initiated to reduce morbidity associated with atherosclerotic cardiovascular disease. A pacemaker was implanted. The anti-platelet dose was reduced from daily, to twice weekly, due to intolerable hemorrhagic complications. Pharmacogenetic testing was ordered as excessive bleeding/bruising continued despite the drastically reduced dose. Result: The MTL pharmacogenetic testing revealed Carol is a CYP2C19 ultra-rapid metabolizer. Her rapidly metabolizing genes result in an increased activation of the originally prescribed anti-platelet drug. This information allowed Carol’s physician to select an alternative anti-platelet medication that works better for her body. Dr. Kelly Fobes’ Comments: This makes perfect sense! Carol was converting the inactive pro-drug into active anti-platelet drug at an exceptionally rapid rate (as this step in drug metabolism is catalyzed by the hepatic isoenzyme, coded for by the CYP2C19 gene). Excessive platelet inhibition likely resulted in the observed hemorrhagic complications. Genetic variations in the activity of the CYP2C19 gene are very common. Ultra-rapid metabolizer status occurs in roughly 25-30% of Caucasians, while roughly 10-15% of the population has reduced CYP2C19 activity. This particular drug carries a black box warning in the FDA label, recommending genetic testing for CYP2C19[ET1] . The FDA warns this drug is not effective in reducing morbid events in patients with reduced CYP2C19 activity. This makes sense; the drug is given as an inactive form (a pro-drug) and must be activated by the CYP2C19 gene product. Additional evidence suggests patients who activate this drug too quickly may experience excessive bleeding, as is the case with Carol. Carol called me to share how excited she is to no longer wear long-sleeves to cover up embarrassing bruising on her forearms anymore. Testimonial from Carol: “Molecular Testing Labs has been a God sent saving grace with regards to my medications and health. The Companion Diagnostics for Plavix Therapy DNA test for CYP2C19 has enlightened me about the drug Plavix. Being 63 years old, and already being implanted with a pacemaker at 61, coupled with refusal of two stents then and now, the importance of your DNA Testing truly has offered me the additional ammunition I need to bring to my lifetime doctor, my cardiologist and my neurologist. I have fought off stent placement for two years. My diet and exercise are optimal for a person who is genetically predisposed for cardiovascular disease. Because of Molecular Testing Labs testing, I now can ask for a safer and alternative medicine to Plavix. My panel from Molecular Testing Labs showed me results in medical terms and language that a well-informed patient can easily understand. I especially liked the color coding of my DNA testing, and the extensive suggestive list of all types of safer and alternative prescription drugs. Because of Molecular Testing Labs, I can now ask my medical team to remove me off of the twice a week Plavix due to being a rapid metabolizer (flagged in the red zone). My quality of life will improve as I won’t have to wear long sleeves due to the hemorrhagic bleeding visible in my forearms. I believe this company truly offers a great, life-saving service. Too many people, unfortunately, don’t understand the radical effect blood thinners truly do have. Plavix has a FDA Black Box Warning for a reason. All patients should be made aware by their healthcare providers that there is the existence of tests that can identify the genetic differences in their patients’ CYP2C19 metabolic function. Sadly this doesn’t occur. But thanks to Molecular Testing Labs, patients can ask their doctor for this test. While it may be true, most insurance companies won’t pay for this type of test, the extremely low fee charged for this type of testing is nominal and pretty much within the average person’s budget. Thank you, Molecular Testing Labs, for keeping it very affordable. I also want to extend my appreciation to the entire staff. I’ve made numerous telephone calls to Molecular Testing Labs regarding my results. I thank them from the bottom of my diseased heart for giving me the dignity of being a well-informed and proactive patient. The staff always responded promptly to all of my questions. I’ve photocopied all my test results and ensured that the doctors on my current team, which is close to 7, reviewed and discussed Molecular Testing Labs with me. It’s nice to have many of my doctors highly impressed with the testing done. I have strongly recommended Molecular Testing Labs for their patients. In gratitude, Carol Orange, CA PS: Thanks a million Kelly……..honestly if I were ten years younger, I’d apply for a field rep position as I’m retired from a business ownership in sales and marketing. I absolutely love everything your company does….your brochure is great, your test results and all the data is very well presented, too. I wish nothing but more success for you.