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Effects of individualized antiplatelet therapy based on CYP2C19 genotype and platelet function on the prognosis of patients after PCI.
- Source :
-
European review for medical and pharmacological sciences [Eur Rev Med Pharmacol Sci] 2020 Oct; Vol. 24 (20), pp. 10753-10768. - Publication Year :
- 2020
-
Abstract
- Objective: To evaluate the effect of individualized antiplatelet therapy based on CYP2C19 genotype and platelet function on the prognosis of patients after percutaneous coronary intervention (PCI) compared with conventional antiplatelet therapy.<br />Patients and Methods: Patients diagnosed with acute coronary syndromes (ACS) in Shandong Provincial Qianfoshan Hospital from December 2014 to December 2017 were included in this prospective study and randomly divided into conventional (CA) and individualized antiplatelet therapy group (IA) at 1:1 ratio. Patients in the CA group received clopidogrel 75 mg once a day (QD). Group IA was divided into extensive, intermediate, and poor metabolizers according to the results of the CYP2C19 gene test. Three genotypes were given clopidogrel 75 mg QD, 75 mg twice daily (BID) and ticagrelor 90 mg BID respectively. After taking these medicines for a period of time, platelet function was monitored by thromboelastography (TEG) and MAADP values were recorded. MAADP indicates the adenosine diphosphate (ADP) induced platelet function that not inhibited by medicine. High platelet reactivity (HPR) was defined as MAADP > 47mm, indicating a high risk of thrombus, and MAADP ≤ 31 mm indicates a high risk of hemorrhage. For extensive metabolizers (EMs) and intermediate metabolizers (IMs) patients with HPR, the antiplatelet therapy would be changed by the clinician according to the patient's conditions. Major adverse cardiovascular events (MACE) and hemorrhage events were monitored during 1-year follow-up.<br />Results: The patients with MAADP > 47 mm were 89 (28.6%) in the IA group. There were 50 EMs patients with MAADP > 47 mm (33.3%). Of which, there were 2 cases which changed the dosage of clopidogrel to 75 mg BID, 14 cases who changed clopidogrel to ticagrelor. There were 36 IMs patients with MAADP > 47 mm (30.8%). Of which, there were 19 cases who changed clopidogrel to ticagrelor. There was no significant difference in the value of MAADP between EMs and IMs patients. Within 1 year after PCI, the occurrence of MACE in the IA group was significantly lower than that in the CA group (p=0.010).<br />Conclusions: (1) Patients with a CYP2C19 loss-of-function (LOF) gene who take double doses of clopidogrel overcome the decreased efficacy of clopidogrel which partly due to CYP2C19 LOF gene, without increasing the risk of hemorrhage. (2) Individualized antiplatelet therapy based on CYP2C19 genotype and platelet function can significantly reduce the occurrence of MACE (mainly acute non-fatal myocardial infarction) after PCI without increasing the risk of moderate or severe hemorrhage.
- Subjects :
- Acute Coronary Syndrome diagnosis
Blood Platelets drug effects
Clopidogrel administration & dosage
Cytochrome P-450 CYP2C19 metabolism
Dose-Response Relationship, Drug
Female
Genotype
Humans
Male
Middle Aged
Platelet Aggregation Inhibitors administration & dosage
Platelet Function Tests
Ticagrelor administration & dosage
Acute Coronary Syndrome drug therapy
Clopidogrel pharmacology
Cytochrome P-450 CYP2C19 genetics
Percutaneous Coronary Intervention adverse effects
Platelet Aggregation Inhibitors pharmacology
Ticagrelor pharmacology
Subjects
Details
- Language :
- English
- ISSN :
- 2284-0729
- Volume :
- 24
- Issue :
- 20
- Database :
- MEDLINE
- Journal :
- European review for medical and pharmacological sciences
- Publication Type :
- Academic Journal
- Accession number :
- 33155236
- Full Text :
- https://doi.org/10.26355/eurrev_202010_23436