Evaluation of clopidogrel response variability and identification of the CYP2C19 polymorphism in Mexican patients

Evaluation of clopidogrel response variability and identification of the CYP2C19 polymorphism in Mexican patients

Drug inhibition of platelet P2Y12 adenosine diphosphate receptor has reduced the incidence of adverse cardiovascular events after percutaneous coronary interventions. The analysis of the phosphorylation status of vasodilator-stimulated phosphoprotein by flow cytometry has shown a predictive value fo...

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Bibliographic Details
Published in:Archivos de cardiología de México Vol. 86; no. 4; pp. 297 - 304
Main Authors: Viveros, Martha Eva, Areán, Carlos, Gutiérrez, Sergio, Vázquez, Soledad, Cardiel, Mario Humberto, Taboada, Alejandra, Marín, Gissela, Solorio, Ruben, García, Nalley
Format: Journal Article
Language:English
Published: Mexico 01-10-2016
Subjects:
Cross-Sectional Studies
Cytochrome P-450 CYP2C19 - genetics
Female
Humans
Male
Mexico
Middle Aged
Platelet Aggregation Inhibitors - therapeutic use
Polymorphism, Genetic
Ticlopidine - analogs & derivatives
Ticlopidine - therapeutic use
Polimorfismo CYP2C192
VASP analysis
Receptor P2Y12
Clopidogrel resistance
P2Y12
Resistencia a clopidogrel
Análisis VASP
Mexico
México
Alta reactividad plaquetaria en tratamiento
CYP2C192 polymorphysm
High on treatment platelet reactivity
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Summary:Drug inhibition of platelet P2Y12 adenosine diphosphate receptor has reduced the incidence of adverse cardiovascular events after percutaneous coronary interventions. The analysis of the phosphorylation status of vasodilator-stimulated phosphoprotein by flow cytometry has shown a predictive value for adverse events and stent thrombosis. Polymorphisms of CYP2C19 in high risk patients may also relate to adverse cardiovascular events. Ninety patients were enrolled. Patients received a 600mg clopidogrel loading dose. Blood samples were obtained at the time of the procedure and 24h later, platelet reactivity was assessed by vasodilator-stimulated phosphoprotein phosphorylation measurement using flow cytometry. Low response to clopidogrel was defined as a platelet reactivity index≥50%. The presence of CYP2C19*2 was identified with the restriction enzyme SmaI. Mean platelet reactivity index: 53.45±22.48% in the baseline sample and 57.14±23.08% at 24h (p=0.183); 40% of patients behaved as good responders, the rest behaved as non-responders with 38% of patients showing platelet reactivity indexes between 50-70% and 22% showing indexes above 70%. The CYP2C19*2 polymorphism was found in 17% of patients, with a 3.9% AA homozygous genotype carriers. Response to the clopidogrel loading dose showed a wide variability among patients with 40% responding to the drug according to previously established cut-off values. Our results showed that 3.9% of patients show the AA genotype. To our knowledge, this is the first study involving clopidogrel response by flow citometry and genotype typification in Mexican Mestizo population.
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ISSN:1405-9940
DOI:10.1016/j.acmx.2016.01.007