Cytochrome P450 2D6 Genotyping for Post-Operative Opioids.

Within most electronic medical records, automated decision support helps health care providers reduce the frequency of adverse drug reactions. Historically, this decision support has been used to prevent drug-drug interactions (DDIs). More recently, the clinical and scientific communities have been moving toward the use of this approach to predict and prevent drug-gene interactions (DGIs). Genetic variation in cytochrome P450 2D6 (CYP2D6) is known to impact clinical outcome for many drugs, including opioids. Randomized trials have been initiated to assess the utility of CYP2D6 gene-based dosing versus usual care. We review the use of this approach to guide opioid prescribing in the post-operative setting.

Aspirin in Primary and Secondary Prevention of Cardiovascular Disease.

Aspirin is one of the most widely used drugs for the treatment of cardiovascular disease. While its use in patients with known cardiovascular disease has been supported with trials which have included mortality benefit, the utility of aspirin therapy in patients without established cardiovascular disease has been less clear. Early trials appeared to demonstrate benefit with the use of aspirin, but trials after 2000 did not consistently substantiate using aspirin for primary prevention of cardiovascular disease. Despite the lack of robust supportive evidence, aspirin was recommended and used extensively for primary prevention in patients at higher risk for cardiovascular events. More recently in 2018, results of three randomized, controlled trials: ARRIVE, ASCEND, ASPREE demonstrated modest to no benefit in preventing cardiovascular events and mortality with aspirin use for primary prevention. These trials also demonstrated an increased risk of bleeding in these patients who were on aspirin for primary prevention.