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Besides CYP2C19*2, the variant allele CYP2C9*3 is associated with higher on-clopidogrel platelet reactivity in patients on dual antiplatelet therapy undergoing elective coronary stent implantation
- Source :
- Pharmacogenetics and Genomics. 20:18-25
- Publication Year :
- 2010
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2010.
-
Abstract
- The prodrug, clopidogrel, plays an important role in the prevention of thrombotic events in patients undergoing coronary stenting. However, a substantial number of atherothrombotic events still occur, which can partially be explained by heightened residual platelet reactivity. Several studies report that the genetic variation in CYP2C19 (*2) is associated with an impaired response to clopidogrel.To evaluate the effect of genetic variants affecting clopidogrel's absorption (ABCB1 C1236T, G2677T/A, C3435T), metabolism (CYP2C9*2, *3, CYP2C19*3, CYP3A4*1B, and CYP3A5*3), and pharmacodynamics (P2Y1 A1622G) on top of the influence of CYP2C19*2 on platelet reactivity in patients undergoing elective coronary stenting on dual antiplatelet therapy.Platelet function was assessed by light transmittance aggregometry and VerifyNow P2Y12 assay in 428 consecutive patients. Patients were either on chronic clopidogrel maintenance therapy (75 mg/day foror =5 days before the intervention) or received a 300 mg clopidogrel loading dose (1-5 days before the intervention, followed by 75 mg/day). Linear and logistic regressions were used to assess the associations between genetic variants and platelet reactivity and poor responder status.In both the treatment groups, CYP2C19*2-carriage was associated with higher platelet reactivity (P0.002) and poor responder status; 75 mg group: adjusted odds ratio (ORadj): 3.8, 95% confidence interval (CI): 2.0-7.2, 300 mg group: ORadj: 4.1, 95% CI: 1.6-10.4. In the 300 mg group, CYP2C9*3-carriage was associated with higher platelet reactivity (P0.05) and poor responder status (ORadj: 11.1, 95% CI: 1.6-78.8, P=0.016).Besides CYP2C19*2, the variant allele CYP2C9*3 plays an important role in the response to clopidogrel in patients on dual antiplatelet therapy undergoing coronary stenting.
- Subjects :
- Blood Platelets
Male
medicine.medical_specialty
Ticlopidine
Genotype
Platelet Function Tests
medicine.medical_treatment
Coronary Disease
CYP2C19
Internal medicine
Coronary stent
Genetics
medicine
Humans
Platelet
Prospective Studies
cardiovascular diseases
General Pharmacology, Toxicology and Pharmaceutics
Prospective cohort study
Molecular Biology
CYP2C9
Alleles
Genetics (clinical)
Cytochrome P-450 CYP2C9
Dose-Response Relationship, Drug
biology
business.industry
Genetic Variation
Middle Aged
Clopidogrel
CYP2C9*3
Cytochrome P-450 CYP2C19
Haplotypes
Cardiology
biology.protein
Molecular Medicine
Female
Stents
Aryl Hydrocarbon Hydroxylases
business
Platelet Aggregation Inhibitors
Pharmacogenetics
medicine.drug
Subjects
Details
- ISSN :
- 17446872
- Volume :
- 20
- Database :
- OpenAIRE
- Journal :
- Pharmacogenetics and Genomics
- Accession number :
- edsair.doi.dedup.....2124a1d5019e1cd2ac27bbaea0d8d08a
- Full Text :
- https://doi.org/10.1097/fpc.0b013e328333dafe