Genetic testing offered to eliminate repeat stroke risk

The National Institute for Health and Care Excellence (NICE) has issued new guidance on drugs which can prevent future attacks following advice that patients who have suffered a stroke should book a DNA test.

A watchdog has announced that people who have had a stroke due to a blood clot – known as an ischaemic stroke which is where a clot blocks the flow of blood and oxygen to the brain – should be tested on the NHS.

The reason stroke patients should be tested is due to the standard anti-clot drug, clopidogrel only works well for people with certain genes. The drug, which prevents platelets – a type of blood cell – from sticking together and forming clots – is currently recommended by NICE as an option for treating people at risk from having another stroke.

However, individuals with certain variations in a gene called CYP2C19 cannot have the drug as they cannot convert it for proper use in their body. Recent research shows 32% of people in the UK are thought to have at least one of the CYP2C19 gene variants and evidence suggests they have around a 46% increased risk of another stroke if they take the drug compared to those without the variant.

According to guidance from NICE, recurrent or repeat strokes make up almost half of the 100,000 that happen each year in the UK. People who have had a ‘mini-stroke’, otherwise known as a transient ischaemic attack, also carry a higher risk so should be offered the gene check to.

Mark Chapman, Interim Director of Medical Technology and Digital Evaluation at NICE, said: ‘The recommendation is a step forward in ensuring people who have had a stroke receive personalised care thanks to a genetic test run after their DNA is sequenced using their blood or saliva.

‘Treatment with clopidogrel is effective in preventing further strokes for the majority of people who don’t have the gene variant.

‘But, until now, doctors have not known who cannot be treated with clopidogrel until after they’ve had a second stroke or TIA and that could be too late.

‘If the CYP2C19 variants are found, other treatment options can be used. This test ensures we’re getting the best care to people quickly, while at the same time ensuring value for money for the taxpayer.’

If laboratory testing of the genes – estimated to cost around £139 per test – is not possible, NICE have claimed the Genomadix Cube test – costing £197 – which is given at the bedside can be used instead.

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