Philosophers speak of a midpoint between two extremes as a ‘golden mean’. Public-policy-makers call an economy that is neither overheated nor undercooled a ‘Goldilocks’ scenario. The school-of-life teaches that a good approach to most situations is moderation.
So it is with people who have suffered a heart attack, and are now on anti-aggregant medication. They clearly want to avoid one extreme – the repeated formation of arterial blood clots – that triggered the heart attack in the first place. At the same time, they also want to avoid the other extreme that also can be life-threatening, uncontrolled bleeding.
As with so many things, finding the golden mean is easier said than done.
To keep blood at its ‘just-so’ level of clotting, doctors today have two main medicinal options, both with pros and cons. One is to prescribe an anti-platelet drug, called clopidogrel, that is proven, relatively low-cost, but fails to work effectively in some patients. The other is to dispense another platelet inhibitor, called prasugrel, that is more expensive and in some cases can work too well, causing patients to bleed more excessively, even fatally so.
So doctors are faced with a tricky decision. There probably is no perfect answer, but a blood-test solution from Roche promises to make their choice more informed.
An instrument called the Multiplate analyzer can, in a blood test that takes only ten minutes, deliver an assessment of a patient’s cellular clotting capability, mediated via blood platelets. Using a sample of ordinary blood (not centrifuged or processed), this diagnostic device (about the size of a typical desktop computer) can guide the doctor’s decision about whether to go with clopidogrel or prasugrel.