Know a patient's molecular genotype for cardiac disorders and response to cardiac therapies

Exceltox offers an extensive menu of testing for cardiac disorders that can help determine the risk of thrombosis or prothrombin deficiency to ultimately guide therapy decisions for commonly prescribed drugs for cardiovascular disease.

Factor II and Factor V Leiden

Factor II and Factor V are important components of the coagulation cascade. Testing for Factor ll and Factor V Leiden mutations provides important information in a differential diagnosis for the clinical presentation of thrombophilia. Factor V is the most common variant associated with inherited thrombosis, with a population frequency ranging from 3-8% in the United States. Factor II is the second most common mutation — present in 1-2% of the general population.

Based on the dominant mode of inheritance, the testing of direct family members (parents, siblings and children) is strongly recommended.

Exceltox - Factor II and Factor V Leiden

CYP450 2C19 and 2D6

Plavix® (clopidogrel) is the world’s second most prescribed drug. Variation in Cytochrome P450 2C19-mediated metabolism is a key source of variability underlying patient reaction to Plavix (clopidogrel).1

CYP450 D6 testing may also be considered medically necessary for patients with cardiovascular disease who are undergoing treatment with certain drugs.

According to recent studies, genetic testing for variations in CYP2D6 and CYP2C19 may result in improved patient management, a decrease in episodes of drug toxicity, drug selection and/or dosage adjustment informed by genetic testing for variations in CYP450 2C19 and 2D6 may also enable improved pain and fewer adverse drug interactions.2-4

Warfarin Sensitivity

Warfarin interferes with the recycling of Vitamin K, which can result in reduced activation of several clotting factors and diminished clotting ability. Consequently, bleeding complications are a highly prevalent cause of morbidity and mortality in patients who receive warfarin.5

A recent study revealed that warfarin genotyping reduced the risk of hospitalization due to thromboembolism or bleeding in outpatients. It concluded that genotyping should be strongly considered in patients beginning warfarin treatment.6

According to the FDA, all patients who are candidates for Coumadin (warfarin) therapy should be tested for their genotype prior to initiating treatment.7

Benefits

Factor II and Factor V Leiden may provide important information in a differential diagnosis for the clinical presentation for thrombophilia.

Adheres to FDA guidelines that require genotyping prior to initiating treatment.

May help physicians implement the appropriate drug and dosage to minimize the risk of minor to life threatening reactions and ensure optimal response.

Test Menu

Factor II

Prothrombin

Factor V Leiden

Inherited Thrombophilia

CYP450 2C19

Platelet Inhibitor Metabolism

CYP450 2D6

Beta Blocker Metabolism

Warfarin sensitivity

References

Mega, et al. JAMA. 2010;304:1821-30.
Jannetto PJ, Bratanow NC. Pain management in the 21st century. Expert Opin Drug Metab Toxicol. 2011;7:745-752.
De Gregori M, Allegri M, De Gregori S, et al. How and why to screen for CYP2D6 interindividual variability in patients under pharmacological treatments. Curr Drug Metab. 2010;11:276-282.
Rollason V, Samer C, Piguet V, et al. Pharmacogenetics of analgesics. Pharmacogenomics. 2008;9:905-933.
Wysowski D, et al. Bleeding Complications With Warfarin Use. Arch Intern Med 2007;167(13):1414-1419.
Epstein et al. Warfarin Genotyping Reduces Hospitalization Rates. J Am Coll. Cardiol; 2010;55:2804-12.
FDA, Black Box Warning, Coumadin, October 2006.