- Radiolabeled Peptides: Overcoming The Challenges of Post-Surgical Patient Management of Venous Thromboembolism
- Marc P.Bernarducci, Pharm.D., M.B.A.- Current Medical Directions, Inc., New York, New York
The serious clinical and economic impact of venous thromboembolic (VTE) disease is undisputed. What concerns practitioners and researchers alike is the seeming inability to truly mitigate the ramification of VTE, especially in the post-surgical or postoperative subpopulation, in whom the risk of VTE is disproportionately high and often asymptomatic. Ironically, current approaches to the diagnostic evaluation of suspected VTE patients tend to favor the application of anatomic modalities, either invasive or technically challenging (eg, venography) or the performance of which is clinically inadequate (eg, ultrasonography) for post-surgical/postoperative patients. These modalities' primary principle of detection rely on the effects or results of an intricate pathophysiologic process, seemingly ignoring the critical role and potentially better prognostic value of endogenous hemostatic mechanisms. In other words, are we using the correct tools to seek the appropriate types of information in patients with suspected VTE? Research in nuclear medicine techniques for detecting VTE began approximately 25 years ago. Recently, the emergence of radiolabeled peptides as a clinically applicable technology platform has encouraged a different approach to evaluating VTE. Many radiolabeled peptide candidates are undergoing preclinical and clinical research. Currently,only one, 99'Tc-apcitide (AcuTect), has been approved (since 1998) for clinical use in the United States. The growing numbers of physicians with experience using 9mTc-apcitide (including those who remember using "'In-fibrinogen) has fueled ongoing clinical research to further elucidate the benefits of this unique peptide technology. Consequently, significant insight has been gained from large prospective clinical tri-als, of which one was conducted to support the approval of 99mTc-apcitide in Europe. Furthermore, this insight has kindled increasing interest in 99'Tc-apcitide and potential new entrants into this special " diagnostic class" (ie, radiolabeled peptides). Unlike the more popular anatomic modalities, radiolabeled pep-tides circumvent many of the clinical and anatomic challenges to objectively and accurately diagnose VTE. The importance of an objective and accurate diagnosis is understood, because it is paramount to a cost-effective treatment strategy. In addition to describing the current activities concerning the development and use of radiolabeled peptides for clinical practice, this manuscript is intended to promulgate a thought-provoking argument for changing our current approach to the diagnostic evaluation of VTE,which also may transcend the post-surgical/postoperative subpopulation.