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Blood thinner really doing it’s job?

Vishal Gupta (name changed) is on long-term dialysis due to kidney failure. His hemodialysis treatment at a nearby dialysis center three times a week is a lifesaving treatment for him. So, when the specially created blood vessel (called an arteriovenous fistula or AV fistula) on his arm which enables the dialysis, got suddenly blocked, he was extremely worried. His doctor planned for another fistula surgery on his other arm, but it would take nearly 2 months before the new fistula would be ready for use in dialysis. In the two months in the meantime, Vishal had to be dialyzed through a tube inserted in a vein in his neck, which was extremely traumatic for him. He wondered how and why his working fistula got blocked, when he was already on clopidogrel (anti-clotting medicine) therapy which should have prevented any clotting that blocked the fistula.

His doctor mentioned that sometimes it can happen despite clopidogrel therapy. Not satisfied, and wanting to protect his new fistula, Vishal took a second and third opinion, and learnt from a different doctor that its possible to test for clopidogrel effectiveness for each person based on a DNA test. He looked up the test online and bought the same. He showed the results to his doctor, which mentioned that he was a slow metabolizer of CYP2C19, and that clopidogrel is contraindicated as it would not work too well to prevent clots for him. The doctor then prescribed a different anti-clotting agent to Vishal, one that does not use CYP2C19 metabolism. Vishal believes he has saved himself some future problems by changing his medicine.

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