Nottingham University Hospitals (NUH) has become one of a handful of hospitals across the UK to implement a rapid genetic test which could dramatically improve outcomes for thousands of stroke patients in the future.
The simple cheek swab test can identify within just one hour whether the patient will benefit from being given the most common drug used to treat strokes – clopidogrel - or whether the patient requires a different medication in order for treatment to be effective.
The test identifies whether the patient has the CYP2C19 gene variation seen in 1 in 3 people, which means that their bodies do not respond to around 40 drugs including clopidogrel.
However, this information will be vitally important for the patient’s overall healthcare as some of the other ineffective medications for them include heart medication such as Warfarin, some anti-depressants, drugs used to treat anxiety, indigestion, and some statins.
The National Institute for Health and Care Excellence (NICE) is planning to use NUH as an exemplar in their guidance for genetic testing for stroke patients.
The initial stroke test pilot is taking place in a brand-new dedicated and permanent clinic space created at the Queen’s Medical Centre specifically for patients requiring assessment and treatment following a suspected minor stroke.
Patients who are believed to have experienced a minor stroke or a Transient Ischemic Attack (TIA or ‘mini-stroke’) will continue to receive rapid assessments from the TIA team, but in this purpose-built clinic, open seven days a week.
A TIA is a temporary blockage of blood flow to the brain causing stroke-like symptoms and can be a warning sign ahead of more significant strokes.
Dr Kailash Krishnan, Consultant and Head of Stroke Medicine at NUH, is leading the pilot for testing the CYP2C19 gene variation, which is then expected to be rolled out permanently for stroke patients attending NUH.
He explained that whilst some other hospitals have used blood genetic testing to identify this genetic variation, it can take three to seven days to receive the results, rather than the one hour this cheek swab test offers.
Dr Krishnan said: “The risk for patients waiting for blood test results is that if they have had one stroke or TIA, they are at a much higher risk of having another, more significant stroke or a heart attack, which could lead to severe disability or death.
“If they have this genetic variation, the most common treatment for their initial stroke will not be working at all.
This rapid test can be done in the hospital while we are carrying out other brain and neck scans, and allows us to make the changes to the patient’s treatment all on the same day. We can therefore be confident that this test will save lives
Dr Kailash Krishnan
“The results could also have huge ramifications for other treatment the patient is receiving, as medications which may not be working for them because of their genetic variation can also be adjusted.”
The results of the genetic test will be added to the patient’s notes on our Nervecentre system to ensure other clinicians are also aware when considering medication as part of their treatment. A detailed letter including these results and adjustment to treatment will also be forwarded to the patient’s GP.
Around 200 patients a month are supported by the TIA clinic, including appropriate SDEC patients to help them to avoid needing to be admitted to a stroke ward.
Amanda Davies, Service General Manager for Stroke at Nottingham University Hospitals NHS Trust, said:
“This is a hugely exciting time for Stroke Services here at NUH thanks to this new clinic space and innovations in treatment which could transform the lives of our patients.
“Our TIA clinic hasn’t had permanent home in recent years, so moving into a purpose-built space designed specifically for patients will make a big difference both to their experience, as well as providing a lovely working environment for our staff.
“I’d like to say a huge thank you to colleagues from across the Trust for making this happen, and for ensuring this space is as good as it possibly can be for everyone who needs to visit.”
Patients are referred to the TIA clinic through their GP, the ambulance service, inpatient areas, or directly from the A&E Department, and the service aims to see patients within 24 hours of the onset of symptoms in order to reduce the risk of a stroke and prevent them from needing to be admitted to hospital.
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