Strokes cost the NHS more than £3 billion every year16 Feb 2023 08:19
There are more than 100,000 strokes in the UK every year, resulting in 38,000 deaths and long-term disability for two-thirds of survivors.
While the estimated annual cost to the NHS is £3.4 billion, when taking into consideration the societal cost (loss of productivity in stroke victims of working age, unpaid carer hours, and so forth) the total actual cost to the economy is believed to be an astonishing £26 billion annually.
Following a stroke, secondary prevention medications are prescribed to reduce the risk of future events.
One of these is clopidogrel, an anti-platelet agent that lowers the risk of secondary thrombosis by impairing platelet aggregation via indirect effects on vascular inflammation and endothelial function.
Point-of-care tests fit well with recommendations for genotyping patients prior to administering clopidogrel.
Genetics laboratories remain distant from patients and may have up to two-week turnaround times, whereas treatment should be prescribed within 24 hours. Genedrive’s CYP2C19 kit aims to deliver a result in less than an hour.
If you want to have a genetic result within a day, you need a device near a patient.
The National Institution of Clinical Excellence (NICE) and the British National Formulary (BNF) recommends treatment with clopidogrel as a single anti-thrombotic agent following ischaemic stroke, but for those carrying CYP2C19*2 or CYP2C19*3 loss-of-function alleles, clopidogrel has no discernable clinical benefits, leaving them vulnerable to composite cerebrovascular events.
Clopidogrel is a crucial stroke secondary prevention measure
Clopidogrel is a prodrug, relying on the CYP2C19 liver enzyme for activation before it can exert its intended effect.
Up to one in five people are unable to convert clopidogrel into its active form, rendering it ineffective.
Identifying these one in five patients on arrival in accident and emergency is an opportunity to transform their medical management.
Those resistant to clopidogrel can be given an appropriate alternative, such as aspirin combined with dipyridamole, or Ticagrelor.
This drug, while linked to higher bleeding rates and costs, is still potentially lifesaving when given to the right people.
The clinical benefit of CYP2C19 genotyping is well documented in scientific literature when it comes to protecting against new strokes or myocardial infarction.
Recently, genedrive’s CYP2C19 ID testing kit, which identifies people carrying the loss-of-function mutation conferring inadequate metabolisation of clopidogrel, has been included in NICE’s recent DAP programme – a testament to its recognised potential for enhancing treatment.
Pharmacogenetic testing could revolutionise stroke outcomes
The Royal College of Physicians and the British Pharmacological Society publicly support the case for the speedy introduction of widespread pharmacogenetic testing across the UK.
It already has an established role in cancer and heart dis
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