A study on the impact of CYP2C19 genotype and platelet reactivity assay on patients undergoing PCI

Abstract Background A thorough understanding of the patient's genotype and their functional response to a medication is necessary for improving event free survival. Several outcome studies support this view particularly if the patient is to be started on clopidogrel due to the prevalence of clo...

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Published in:	Indian heart journal Vol. 67; no. 2; pp. 114 - 121
Main Authors:	Rath, P.C, Chidambaram, Sundar, Rath, Pallavi, Dikshit, Byomakesh, Naik, Sudhir, Sahoo, Prashant K, Das, Brajraj, Mahalingam, Mohanshankar, Khandrika, Lakshmipathi, Jain, Jugnu
Format:	Journal Article
Language:	English
Published:	India Elsevier B.V 01-03-2015 Elsevier
Subjects:	Adenosine - analogs & derivatives Adenosine - therapeutic use Cardiovascular Coronary Artery Disease - blood Coronary Artery Disease - genetics Coronary Artery Disease - therapy CYP2C19 genotype Cytochrome P-450 CYP2C19 - genetics Cytochrome P-450 CYP2C19 - metabolism DNA - genetics DNA Mutational Analysis Drug Resistance - genetics Female Follow-Up Studies Genotype Humans Male Middle Aged Mutation Original PCI Percutaneous Coronary Intervention Platelet Activation - genetics Platelet Aggregation Inhibitors - therapeutic use Platelet reactivity assay Polymerase Chain Reaction Prasugrel Hydrochloride - therapeutic use Purinergic P2Y Receptor Antagonists - therapeutic use Retrospective Studies Ticlopidine - analogs & derivatives Ticlopidine - therapeutic use Platelet reactivity assay CYP2C19 genotype PCI
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Summary:	Abstract Background A thorough understanding of the patient's genotype and their functional response to a medication is necessary for improving event free survival. Several outcome studies support this view particularly if the patient is to be started on clopidogrel due to the prevalence of clopidogrel resistance. Such guided therapy has reduced the incidence of Major Adverse Cardiac Events (MACE) after stent implantation. Methods Between August 2013 and August 2014, 200 patients with coronary artery disease undergoing percutaneous coronary intervention (PCI) were prescribed any one of the anti-platelet medications such as clopidogrel, prasugrel or ticagrelor and offered testing to detect CYP2C19 gene mutations along with a platelet reactivity assay (PRA). Intended outcome was modification of anti-platelet therapy defined as either dose escalation of clopidogrel or replacement of clopidogrel with prasugrel or ticagrelor for the patients in clopidogrel arm, and replacement of ticagrelor or prasugrel with clopidogrel if those patients were non-carrier of mutant genes and also if they demonstrated bleeding tendencies in the ticagrelor and prasugrel arms. Conclusion Clopidogrel resistance was observed to be 16.5% in our study population. PRA was useful in monitoring the efficacy of thienopyridines. By having this test, one can be safely maintained on clopidogrel in non-carriers, or with increased dose of clopidogrel in intermediate metabolizers or with newer drugs such as ticagrelor or prasugrel in poor metabolizers. Patients on ticagrelor and prasugrel identified as non-carriers of gene mutations for clopidogrel metabolism could be offered clopidogrel resulting in economic benefits to the patients. Patients at high risk of bleeding were also identified by the PRA.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0019-4832
DOI:	10.1016/j.ihj.2015.03.017