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Gao H, Yang N, Yang L, Wang H, Zhang G, Ma X, Deng N. Advances and Perspectives in methods for identifying high platelet reactivity. Heliyon 2023; 9:e22214. [PMID: 38107326 PMCID: PMC10724541 DOI: 10.1016/j.heliyon.2023.e22214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 12/19/2023] Open
Abstract
Antiplatelet therapy is the foundational treatment for the prevention and treatment of coronary and cerebrovascular ischemic events in patients with coronary heart disease, ischemic stroke, and transient ischemic attack (TIA). However, with more and more studies reporting an increased risk of thrombosis in some patients due to poor response to therapeutic agents, the selection of appropriate P2Y12 inhibitors has become a major challenge that needs to be addressed urgently. Currently, commonly used oral P2Y12 inhibitors include clopidogrel, ticagrelor, and prasugrel. Assessing patients' risk factors before the development of treatment regimens by effectively predicting the risk of high platelet reactivity with specific P2Y12 inhibitors in advance to avert the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) is the key point to the problem. Up to now, methods available for predicting platelet reactivity include genetic testing, platelet function testing, and risk scores. This review provides a summarization of the existent available identification methods and analyzes the advantages and drawbacks of different methods in specific clinical settings, intending to guide the rational clinical application of P2Y12 receptor inhibitors.
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Affiliation(s)
- Hua Gao
- Department of Pharmacy, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
- School of Pharmacy, Ningxia Medical University, Yinchuan, 750004, China
| | - Nan Yang
- School of Pharmacy, Ningxia Medical University, Yinchuan, 750004, China
| | - Libo Yang
- Heart Centre and Department of Cardiovascular Diseases, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Hui Wang
- Department of Pharmacy, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Guoshan Zhang
- Heart Centre and Department of Cardiovascular Diseases, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Xueping Ma
- Heart Centre and Department of Cardiovascular Diseases, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Ning Deng
- Office of Drug Clinical Trial Organization, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
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Biswas M, Kali SK, Sarker AK, Sukasem C. Association between Q192R PON1 genetic polymorphism and major adverse cardiovascular events in patients treated with clopidogrel: an updated meta-analysis. Expert Opin Drug Saf 2023; 22:807-817. [PMID: 37148265 DOI: 10.1080/14740338.2023.2212152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/18/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Clopidogrel's responsiveness may be affected by the paraoxonase-1 (PON1) enzyme encoded by the Q192R PON1 genetic variant. We aimed to determine the aggregated risk of MACEs associated with carrying Q192R PON1 genetic variant in patients taking clopidogrel. RESEARCH DESIGN AND METHODS Different databases were searched systematically for eligible studies, and risk ratio (RR) was measured using RevMan software where P <0.05 was set statistically significant. RESULTS Nineteen studies were included consisting of 17,815 patients. It was found that patients carrying either homozygous or a combination of heterozygous and homozygous variants were not significantly associated with increased risk of MACEs compared to the non-carriers (QQ vs. RR: RR=0.99, 95% CI 0.69-1.42, P=0.96; QQ+QR vs RR; RR=1.05, 95% CI 0.82-1.35, P=0.70). The risk of MACEs was also not significantly different in other genetic model (QQ vs QR+RR) (RR=1.09, 95% CI 0.93-1.27, P=0.30). Further, bleeding events were not significantly different in different genetic models (QQ vs RR; RR=1.13, 95% CI 0.58-2.21, P=0.71; QQ+QR vs RR; RR=1.09, 95% CI 0.66-1.81, P=0.73; QQ vs QR+RR; RR=1.08, 95% CI 0.76-1.55, P=0.66). CONCLUSIONS The results suggest that the Q192R PON1 genetic polymorphism has no significant impact on the risk of MACEs or bleeding events in patients treated with clopidogrel.
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Affiliation(s)
- Mohitosh Biswas
- Department of Pharmacy, University of Rajshahi, Rajshahi, Bangladesh
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC), Ramathibodi Hospital, Bangkok, Thailand
| | | | - Ashish Kumar Sarker
- Department of Pharmacy, Pabna University of Science and Technology, Pabna, Bangladesh
| | - Chonlaphat Sukasem
- Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC), Ramathibodi Hospital, Bangkok, Thailand
- Pharmacogenomics and Precision Medicine Clinic, Bumrungrad Genomic Medicine Institute (BGMI), Bumrungrad International Hospital, Bangkok, Thailand
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Leocádio PCL, Goulart AC, Santos IS, Lotufo PA, Bensenor IM, Alvarez-Leite JI. Lower paraoxonase 1 paraoxonase activity is associated with a worse prognosis in patients with non-ST-segment elevation myocardial infarction in long-term follow-up. Coron Artery Dis 2022; 33:515-522. [PMID: 36093959 DOI: 10.1097/mca.0000000000001181] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Acute coronary syndrome (ACS) is one of the main manifestations of coronary artery disease, with a higher prevalence and worst prognosis. Oxidative stress is important in atherosclerosis and ACS, and paraoxonase 1 (PON1) is directly related to reducing the effects of oxidative stress on lipoproteins. The present study evaluated the prognostic value of PON1 activity in patients with non-ST-segment elevation ACS [non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina (UA)], included in the ERICO study. METHODS PON1 paraoxonase activity was determined in serum samples from 485 patients collected on admission. The prognostic value in the follow-up of up to 5 years was evaluated according to cutoff points established by tertiles. Kaplan-Meier curves and Cox regression were used for the analysis of all-cause mortality and cardiovascular mortality. RESULTS The sample consisted mainly of elderly patients with a high frequency of cardiovascular risk factors. At follow-up of up to 5 years, there were 126 deaths from all causes (80 deaths from CVD). The lowest tertile of PON1 paraoxonase activity was associated with a higher risk of death in patients with NSTEMI, but not in patients with UA. CONCLUSION PON1 paraoxonase activity has potential prognostic value in patients with NSTEMI.
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Affiliation(s)
- Paola Caroline Lacerda Leocádio
- Departamento de Nutrição, Universidade Federal de Minas Gerais.,Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo horizonte
| | | | - Itamar Souza Santos
- Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da Universidade de São Paulo.,Departamento de Clínica Médica da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Andrade Lotufo
- Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da Universidade de São Paulo.,Departamento de Clínica Médica da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Isabela Martins Bensenor
- Centro de Pesquisa Clínica e Epidemiológica do Hospital Universitário da Universidade de São Paulo.,Departamento de Clínica Médica da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Jacqueline Isaura Alvarez-Leite
- Departamento de Nutrição, Universidade Federal de Minas Gerais.,Departamento de Bioquímica e Imunologia, Universidade Federal de Minas Gerais, Belo horizonte
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Santana-Mateos M, Medina-Gil JM, Saavedra-Santana P, Martínez-Quintana E, Rodríguez-González F, Tugores A. Clinical and pharmacological parameters determine relapse during clopidogrel treatment of acute coronary syndrome. J Clin Pharmacol 2021; 62:783-791. [PMID: 34958683 DOI: 10.1002/jcph.2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/14/2021] [Indexed: 11/06/2022]
Abstract
The therapeutic efficacy of clopidogrel as an anti-platelet drug varies among individuals, being the mainstream hypothesis that its bioavailability depends on the individual genetic background and/or interactions with other drugs. A total of 477 patients receiving double anti-aggregation therapy with aspirin and clopidogrel, after suffering a first event, were followed for 1 year to record relapse, as a surrogate end point to measure their therapeutic response, as defined by presenting with an acute coronary event (unstable angina, STEMI, or NSTEMI), stent thrombosis/restenosis or cardiac mortality. Anthropometric, clinical and pharmacological variables along with CYP2C19 genotypes were analyzed for their association with the disease relapse phenotype. Only 75 patients (15%) suffered a relapse, which occurred during the first six months of therapy, with a peak at 4.5 months. An initial univariate analysis identified that patients in the relapse group were significantly older (67.4 ± 11.0 vs 61.6 ± 12.3 years old) and presented with diffuse coronary disease, insulin-dependent type 2 diabetes mellitus dyslipidemia, and arterial hypertension. A poor clinical response to the platelet anti-aggregation regime also occurred more frequently among patients taking, along with aspirin and clopidogrel, acenocoumarol and Calcium Channel Blockers, while no association was found according to CYP2C19 genotypes. A retrospective multivariate analysis indicated that patients belonging to the non-responder phenotype to treatment with aspirin and clopidogrel were older, presented with diffuse coronary disease, a group largely overlapping with type 2 insulin-dependent diabetes mellitus, and were taking dihidropyrimidinic calcium channel blockers. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - José M Medina-Gil
- Cardiology Department, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | | | - Efrén Martínez-Quintana
- Cardiology Department, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
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Aklillu E, Engidawork E. The impact of catha edulis (vahl) forssk. ex endl. (celestraceae) (khat) on pharmacokinetics of clinically used drugs. Expert Opin Drug Metab Toxicol 2021; 17:1125-1138. [PMID: 34410209 DOI: 10.1080/17425255.2021.1971194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Catha edulis (Vahl) Forssk. ex Endl. (Celestraceae) is used as a recreational drug on daily basis for its euphoric and psychostimulant effects. It is also chewed by individuals who are on medications, raising the possibility of drug-khat interaction. However, limited data are available in the literature, although clinically significant interactions are expected, as khat contains a complex mixture of pharmacologically active constituents. AREAS COVERED It provides an overview of the phytochemistry, pharmacokinetics, pharmacodynamics, and pharmacogenetics of khat based on the literature mined from PubMed, Google Scholar, and Cochrane databases. It also presents a detailed account of drug-khat interactions with specific examples and their clinical significance. The interactions mainly occur at the pharmacokinetics level and particular attention is paid for the phases of absorption and cytochrome P450 enzyme-mediated metabolism. EXPERT OPINION Despite the increasing trend of khat chewing with medications among the populace and the potential risk for the occurrence of clinically significant interactions, there is paucity of data in the literature demonstrating the magnitude of the risk. The available data, however, clearly demonstrate that the consequence of drug-khat interaction is dependent on genotype. Genotyping, where feasible, could be used to improve clinical outcome and minimize adverse reactions.
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Affiliation(s)
- Eleni Aklillu
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Hospital-Huddinge, Stockholm, Sweden
| | - Ephrem Engidawork
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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The influence of acute coronary syndrome on levels of clopidogrel active metabolite and platelet inhibition in patients with and without CYP2C19*2(681 G>A), *3(636 G>A) and ABCB1(C3435C> T) gene polymorphisms. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:179-186. [PMID: 34400920 PMCID: PMC8356835 DOI: 10.5114/aic.2021.106894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 04/20/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Although ticagrelor and prasugrel remain the standard antiplatelet treatments in acute coronary syndrome (ACS), numerous patients still present with indications for clopidogrel use. Aim We aimed to assess the levels of clopidogrel active metabolite and to evaluate the effect of the drug on platelet inhibition in patients with ACS as compared with those with stable coronary disease. Patients were assessed for the presence of the most common genetic polymorphisms that reduce the absorption (ABCB1) and activation (CYP2C19*2 and CYP2C19*3) of clopidogrel to exclude the effect of genetic variability on drug concentrations and activity. Material and methods This single-center, open-label, prospective study included 199 patients hospitalized due to ST-segment elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) in Killip class I–III, who underwent percutaneous coronary intervention. The control group included 22 patients with stable coronary artery disease. Results The mean (SD) levels of active clopidogrel were 17.1 (12.3) ng/ml in controls and 16.4 (12.0) ng/ml in the whole study group (p < 0.68). No differences were noted in clopidogrel levels between patients with STEMI and NSTEMI (mean (SD), 17.6 (2.3) ng/ml and 15.1 (11.5) ng/ml; p < 0.45) or between STEMI and NSTEMI groups and controls (p < 0.38 and p < 0.61, respectively). No effect of ABCB1 or CYP2C19 polymorphism was observed in the study subgroups. Conclusions We concluded that ACS does not affect the levels of clopidogrel active metabolite or platelet inhibition in patients in Killip class I-III with or without CYP2C19 or ABCB1 gene polymorphisms.
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Tanaka K, Matsumoto S, Ainiding G, Nakahara I, Nishi H, Hashimoto T, Ohta T, Sadamasa N, Ishibashi R, Gomi M, Saka M, Miyata H, Watanabe S, Okata T, Sonoda K, Koge J, Iinuma KM, Furuta K, Nagata I, Matsuo K, Matsushita T, Isobe N, Yamasaki R, Kira JI. PON1 Q192R is associated with high platelet reactivity with clopidogrel in patients undergoing elective neurointervention: A prospective single-center cohort study. PLoS One 2021; 16:e0254067. [PMID: 34351918 PMCID: PMC8341610 DOI: 10.1371/journal.pone.0254067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background and purpose The impact of the paraoxonase-1 (PON1) polymorphism, Q192R, on platelet inhibition in response to clopidogrel remains controversial. We aimed to investigate the association between carrier status of PON1 Q192R and high platelet reactivity (HPR) with clopidogrel in patients undergoing elective neurointervention. Methods Post-clopidogrel platelet reactivity was measured using a VerifyNow® P2Y12 assay in P2Y12 reaction units (PRU) for consecutive patients before the treatment. Genotype testing was performed for PON1 Q192R and CYP2C19*2 and *3 (no function alleles), and *17. PRU was corrected on the basis of hematocrit. We investigated associations between factors including carrying ≥1 PON1 192R allele and HPR defined as original and corrected PRU ≥208. Results Of 475 patients (232 men, median age, 68 years), HPR by original and corrected PRU was observed in 259 and 199 patients (54.5% and 41.9%), respectively. Carriers of ≥1 PON1 192R allele more frequently had HPR by original and corrected PRU compared with non-carriers (91.5% vs 85.2%, P = 0.031 and 92.5% vs 85.9%, P = 0.026, respectively). In multivariate analyses, carrying ≥1 PON1 192R allele was associated with HPR by original (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.03–3.76) and corrected PRU (OR 2.34, 95% CI 1.21–4.74) after adjustment for age, sex, treatment with antihypertensive medications, hematocrit, platelet count, total cholesterol, and carrying ≥1 CYP2C19 no function allele. Conclusions Carrying ≥1 PON1 192R allele is associated with HPR by original and corrected PRU with clopidogrel in patients undergoing elective neurointervention, although alternative results related to other genetic polymorphisms cannot be excluded.
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Affiliation(s)
- Koji Tanaka
- Department of Neurology, Graduate School of Medical Sciences, Neurological Institute, Kyushu University, Fukuoka, Japan
| | - Shoji Matsumoto
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Gulibahaer Ainiding
- Department of Neurology, Graduate School of Medical Sciences, Neurological Institute, Kyushu University, Fukuoka, Japan
| | - Ichiro Nakahara
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Hidehisa Nishi
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Tetsuya Hashimoto
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Tsuyoshi Ohta
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Nobutake Sadamasa
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Ryota Ishibashi
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Masanori Gomi
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Makoto Saka
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Haruka Miyata
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | | | - Takuya Okata
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kazutaka Sonoda
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Junpei Koge
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Kyoko M. Iinuma
- Department of Neurology, Graduate School of Medical Sciences, Neurological Institute, Kyushu University, Fukuoka, Japan
| | - Konosuke Furuta
- Department of Neurology, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Izumi Nagata
- Department of Neurosurgery, Kokura Memorial Hospital, Kitakyushu, Japan
| | - Keitaro Matsuo
- Department of Cancer Epidemiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Division of Cancer Epidemiology and Prevention, Aichi Cancer Center Research Institute, Nagoya, Japan
| | - Takuya Matsushita
- Department of Neurology, Graduate School of Medical Sciences, Neurological Institute, Kyushu University, Fukuoka, Japan
| | - Noriko Isobe
- Department of Neurology, Graduate School of Medical Sciences, Neurological Institute, Kyushu University, Fukuoka, Japan
| | - Ryo Yamasaki
- Department of Neurology, Graduate School of Medical Sciences, Neurological Institute, Kyushu University, Fukuoka, Japan
| | - Jun-ichi Kira
- Department of Neurology, Graduate School of Medical Sciences, Neurological Institute, Kyushu University, Fukuoka, Japan
- * E-mail:
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Abstract
Biomarkers have been used in sepsis to assist with the diagnosis of disease as well as determining the severity of disease, that is, prognosis. These biomarkers are based on the presence of discrete molecules within the blood. Unfortunately, in 2020, a single biomarker does not have sufficient sensitivity and specificity to definitively rule in or rule out sepsis. Biomarkers have shown better performance in animal models of disease.
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Affiliation(s)
- Yachana Kataria
- Department of Pathology and Laboratory Medicine, Boston School of Medicine, Boston, MA, USA.
| | - Daniel Remick
- Department of Pathology and Laboratory Medicine, Boston School of Medicine, Boston, MA, USA.
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Lee CH, Franchi F, Angiolillo DJ. Clopidogrel drug interactions: a review of the evidence and clinical implications. Expert Opin Drug Metab Toxicol 2020; 16:1079-1096. [PMID: 32835535 DOI: 10.1080/17425255.2020.1814254] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Patients with cardiovascular disease are commonly affected by a number of comorbidities leading to a high prevalence of polypharmacy. Polypharmacy increases the probability of drug-drug interactions (DDIs). Amongst these, DDIs involving clopidogrel, the most commonly utilized platelet P2Y12 inhibitor, is a topic of potential clinical concern. AREAS COVERED This article reviews DDIs between clopidogrel and drugs which are widely used in clinical practice. In particular, drugs shown to interfere with the pharmacodynamic and pharmacokinetic effects of clopidogrel and the clinical implications of these findings are reviewed. These drugs include inhibitors of gastric acid secretion, statins, calcium channel blockers, antidiabetic agents, and antimicrobial agents. For the references, we searched PubMed, EMBASE, or the Cochrane Library. EXPERT OPINION Clopidogrel-drug interactions are common. Most of these DDIs are limited to laboratory findings showing an impact on clopidogrel-induced antiplatelet effects. While variability in clopidogrel-induced antiplatelet effects is known to affect clinical outcomes, with high platelet reactivity being associated with thrombotic complications among patients undergoing coronary stenting, most studies assessing the clinical implications of clopidogrel-drug interactions have not shown to significantly affect outcomes. However, awareness of these DDIs remains important for optimizing the selection of concomitant therapies.
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Affiliation(s)
- Chang Hoon Lee
- Division of Cardiology, University of Florida College of Medicine-Jacksonville , Jacksonville, FL, USA.,Division of Cardiology, Department of Internal Medicine, Veterans Health Service Medical Center , Seoul, Korea
| | - Francesco Franchi
- Division of Cardiology, University of Florida College of Medicine-Jacksonville , Jacksonville, FL, USA
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine-Jacksonville , Jacksonville, FL, USA
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Zhang Z, Chen M, Zhang L, Zhao Q. The impact of cytochrome 450 and Paraoxonase polymorphisms on clopidogrel resistance and major adverse cardiac events in coronary heart disease patients after percutaneous coronary intervention. BMC Pharmacol Toxicol 2020; 21:1. [PMID: 31900240 PMCID: PMC6942367 DOI: 10.1186/s40360-019-0378-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 12/20/2019] [Indexed: 12/28/2022] Open
Abstract
Background Clopidogrel is an inactive prodrug, it catalyzed into its active form by Cytochrome 450 and Paraoxonase-1(PON-1). polymorphisms of genes encoding these enzymes will affect the efficacy of Clopidogrel. The main objective of our study was to investigate the association of CYP2C19*2, CYP2C19*3 and PON-1Q192R polymorphisms with Clopidogrel resistance and major adverse cardiac events in Jin Hua district in the middle of Zhe Jiang Province in China. Methods One hundred sixty coronary heart disease patients with percutaneous coronary intervention, who were followed-up for 1 year, were enrolled in our study. These patients were co-administered aspirin 100 mg/d and clopidogrel 75 mg/d following a loading dose of 300 mg. The ADP-induced platelet aggregation rate was measured by Platelet aggregator. Genotypes of CYP2C19*2, CYP2C19*3, PON-1Q192R were determined using Sanger sequencing in all patients. Various clinical data were collected. Results The frequencies of CYP2C19*2, CYP2C19*3 and PON-1Q192R homozygous mutant genotypes were significantly lower in non-responders than those in responders. After for all variables, CYP2C19*2, CYP2C19*3 and PON-1Q192R independently increased the risk of clopidogrel resistance with adjusted ORs 46.65(95% CI,1.77–25.04; p = 0.005); 22.74(95% CI, 3.11–166.27; p = 0.002); 5.69 (95% CI,1.06–30.47; p = 0.042). Over a follow-up of 12 months, the incidence of major adverse cardiac events (MACE) in CYP2C19*1/*2, *1/*3, *2/*2, *2/*3 was significantly higher than no mutant genotype (18/40vs.2/63,3/9vs.2/63, 11/6vs.2/63, 7/1vs2/63, respectively). There was no significant correlation between PON-1Q192R mutant allele and MACE. Conclusion Our study was first time to report on CYP2C19 and PON-1 polymorphisms in Jin Hua population in the middle of Zhe Jiang province in China. The carriage of CYP2C19*2 or *3 mutant allele significantly reduced the platelet response to clopidogrel and increase the MACE. The carriage of PON-1 mutant allele also significantly reduced the platelet response to clopidogrel, but would not increase the major adverse cardiac events after 1 year follow-up. Trial registration ChiCTR, ChiCTR1800018316. Registered 11 September 2018 – prospective registered, http://www.chictr.org.cn/edit.aspx?pid=30927&htm=4.
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Affiliation(s)
- Zhaowei Zhang
- Department of Pharmacy, Jin Hua Municipal Central Hospital, Jin Hua, 32100, China.
| | - Mingxiao Chen
- Department of Pharmacy, Jin Hua Municipal Central Hospital, Jin Hua, 32100, China
| | - Long Zhang
- Department of Medical laboratory, Jin Hua Municipal Central Hospital, Jin Hua, 32100, China
| | - Qiang Zhao
- Department of Vascularcardiology, Jin Hua Municipal Central Hospital, Jin Hua, 32100, China
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Su Q, Li J, Tang Z, Yang S, Xing G, Liu T, Peng H. Association of CYP2C19 Polymorphism with Clopidogrel Resistance in Patients with Acute Coronary Syndrome in China. Med Sci Monit 2019; 25:7138-7148. [PMID: 31543510 PMCID: PMC6775793 DOI: 10.12659/msm.915971] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The relationship between clopidogrel-resistance (CR) and polymorphism located in genes encoding clopidogrel metabolism-related enzymes has not been fully explored. Thus far, few studies on CR-associated polymorphism have been conducted in the Chinese population. The purpose of this study was to identify CYP2C19 polymorphism associated with CR in patients with acute coronary syndrome in China. MATERIAL AND METHODS There were 125 patients with acute coronary syndromes (ACS) selected for this study. Of these, 27 patients (21.6%) showed CR (less than 10% reduction in platelet accumulation rate), while the remaining 98 patients (78.4%) were non-clopidogrel-resistant (NCR). RESULTS There were significant differences in the allele frequencies of CYP2C19 (rs4244285) (P=0.03) and CYP2C19 (rs4986893) (P=0.005) between the 2 groups; however, there was no significant difference in allele frequencies of ABCB1 (rs1045642) (P=0.661) and PON1 (rs662) (P=0.690) between the 2 groups. The null allele in the CYP2C19 (rs4244285) [odds ratio (OR)=5.317, 95% confidence interval (CI) 1.542-26.428, P=0.001] and CYP2C19 (rs4986893) (OR=4.295, 95%CI 1.312-17.517, P=0.013) is one of the causes of CR in patients with ACS in China. CONCLUSIONS The CYP2C19 polymorphism (rs4244285 and rs4986893) is the correlative factor of CR in patients with ACS in China. It was found that the null allele in the CYP2C19 polymorphism was related to the higher CR risk. According to the key role of CYP2C19 in the clopidogrel activation and the evaluated role of CYP2C19 in this study, further studies should be carried out to formulate therapeutic alternative methods for CR in patients with ACS.
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Affiliation(s)
- Qiang Su
- Department of Pharmacy, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, Sichuan, China (mainland).,Nanchong Key Laboratory of Individualized Drug Therapy, Nanchong, Sichuan, China (mainland)
| | - Jian Li
- Department of Cardiology, The Second People's Hospital of Yibin, Yibin, Sichuan, China (mainland)
| | - Zhili Tang
- Department of Pharmacy, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, Sichuan, China (mainland).,Nanchong Key Laboratory of Individualized Drug Therapy, Nanchong, Sichuan, China (mainland)
| | - Siyun Yang
- Department of Pharmacy, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, Sichuan, China (mainland).,Nanchong Key Laboratory of Individualized Drug Therapy, Nanchong, Sichuan, China (mainland)
| | - Guoqiang Xing
- Department of Imaging and Imaging Institute of Rehabilitation and Development of Brain Function, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, Sichuan, China (mainland)
| | - Tao Liu
- Nanchong Key Laboratory of Individualized Drug Therapy, Nanchong, Sichuan, China (mainland).,Department of Cardiology, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, Sichuan, China (mainland)
| | - Hong Peng
- Department of Anorectal Surgery, Nanchong Central Hospital, The Second Clinical Medical College, North Sichuan Medical College, Nanchong, Sichuan, China (mainland)
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Alhazzani AA, Munisamy M, Karunakaran G. Pharmacogenetics of CYP2C19 genetic polymorphism on clopidogrel response in patients with ischemic stroke from Saudi Arabia. ACTA ACUST UNITED AC 2019; 22:31-37. [PMID: 28064328 PMCID: PMC5726834 DOI: 10.17712/nsj.2017.1.20160303] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To elucidate the degree of genetic polymorphisms CYP2C19 (CYP2C19*2, CYP2C19*3) of key drug metabolizing enzymes on the antiplatelet effect of clopidogrel response in patients with acute ischemic stroke from Saudi Arabia. METHODS A case-control study carried out at Neurology Clinics at Asser Central Hospital, Abha, Kingdom of Saudi Arabia from October 2015 to January 2016 and included 25 stroke patients responding to clopidogrel therapy and 25 stroke patients non responding to clopidogrel monotherapy. After obtaining their informed consent, the blood samples were collected and genotyped for CYP2C19 polymorphisms by the polymerase chain reaction-restriction fragment length polymorphisms (PCR-RFLP Method). Allele frequencies were derived from genotypic data and platelet aggregation was measured using multiple electrode aggregometry on the multiplate analyser. Chi Square tests, p-values, odds ratio (OR) and corresponding confidence intervals were calculated for each polymorphism. RESULTS The CYP2C19*2 (681G>A) and CYP2C19*3 (636 G>A) polymorphism were seen to be in Hardy-Weinberg equilibrium and showed significant allelic and genotypic association between responders and non-responders to clopidogrel (p<0.01). The CYP2C19*2: allelic chi-square=21.49, p=0.000036, OR=5.52 (2.42-12.83); Genotypic Chi-square=10.27, p=0.001, OR=7.88 (1.78-9.73). The CYP2C19*3: Allelic chi-square=11.66, p=0.0006, OR=3.45 (1.57-7.70); genotypic chi-square=4.37, p=0.036, OR=3.69 (0.90-5.81). The variant allele (homozygous and homozygous Mutant) showed significant influence on platelet inhibition and the antiplatelet effect of clopidogrel in ischemic stroke. CONCLUSION Our findings provide certain evidence on the genetic effect of CYP2C19 on clopidogrel responsiveness in stroke patients from Saudi Arabia.
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Affiliation(s)
- Adel A Alhazzani
- Assistant Professor of Neurology, Department of Neurosciences, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
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13
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Investigating the Effect of Demographics, Clinical Characteristics, and Polymorphism of MDR-1, CYP1A2, CYP3A4, and CYP3A5 on Clopidogrel Resistance. J Cardiovasc Pharmacol 2019; 72:296-302. [PMID: 30422888 DOI: 10.1097/fjc.0000000000000627] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Clopidogrel is an antiplatelet agent that is indicated for cardiovascular emergencies and procedures. The drug, however, is subject to response variability leading to therapy resistance. In this research, we explored the demographic, clinical, and genetic factors associated with clopidogrel resistance. Data analysis among our 280 subjects receiving clopidogrel showed some risk factors that are significantly associated with clopidogrel resistance compared with responders. Those were: female sex (P = 0.021), advanced age (P = 0.011), obesity (P = 0.002), and higher body mass index (P = 0.008) and higher platelets count (P = 0.002). However, known polymorphisms of MDR-1, CYP1A2, CYP3A4, and CYP3A5 were not associated with treatment resistance when compared to responders to clopidogrel therapy. Knowledge about such risk factors might provide recommendation in the future about starting doses or monitoring recommendations.
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14
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Su J, Li J, Yu Q, Xu X, Wang J, Yang J, Li X, Chen X. Association of PON1 gene promoter DNA methylation with the risk of Clopidogrel resistance in patients with coronary artery disease. J Clin Lab Anal 2019; 33:e22867. [PMID: 30891852 PMCID: PMC6595294 DOI: 10.1002/jcla.22867] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/31/2019] [Accepted: 02/01/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND AND AIMS The failure of therapeutic response to clopidogrel in platelet inhibition, which is called clopidogrel resistance (CR), is more likely to cause cardiovascular events. We aimed to study the contribution of promoter DNA methylation of paraoxonase 1 (PON1) to the risk of clopidogrel poor response. METHODS Through VerifyNow P2Y12 assay, patient' platelet functions were measured. Among 57 non-CR and 49 CR patients, the levels of DNA methylation in four CpG dinucleotides on the PON1 promoter were tested using bisulfite pyrosequencing technology. Besides, the relative expression of PON1 mRNA was analyzed by quantitative real-time PCR. Logistic regression was applied to investigate the interaction of PON1 methylation and clinical factors in CR. RESULTS In the subgroup with dyslipidemia, we discovered that higher CpG4 levels of the PON1 promoter indicated a poorer clopidogrel response (cases versus controls (%): 51.500 ± 14.742 vs 43.308 ± 10.891, P = 0.036), and the PON1 mRNA expression was reduced in CR patients. Additionally, the logistic regression indicated that higher level of albumin and the index of ALT were related to a lower risk of CR, and the index of AST as well as the quantity of stent may be positively associated with CR. CONCLUSIONS The DNA methylation of CpG4 in the PON1 promoter would lead to a low expression of PON1 mRNA, which might induce clopidogrel resistance in the patients with dyslipidemia, and the number of stents might be a risk for CR.
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Affiliation(s)
- Jia Su
- Department of Cardiology, Ningbo No. 1 Hospital, Ningbo, Zhejiang, China
| | - Jiyi Li
- Department of Cardiology, Ningbo No. 1 Hospital, Ningbo, Zhejiang, China
| | - Qinglin Yu
- Department of Traditional Chinese Internal Medicine, Ningbo No. 1 Hospital, Ningbo, Zhejiang, China
| | - Xiaofeng Xu
- Department of Cardiology, Ningbo No. 1 Hospital, Ningbo, Zhejiang, China
| | - Jingqiao Wang
- Department of Cardiology, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang, China
| | - Jin Yang
- Department of Cardiology, Ningbo No. 1 Hospital, Ningbo, Zhejiang, China
| | - Xiaojing Li
- Department of Cardiology, Ningbo No. 1 Hospital, Ningbo, Zhejiang, China
| | - Xiaomin Chen
- Department of Cardiology, Ningbo No. 1 Hospital, Ningbo, Zhejiang, China
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15
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16
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Hernandez-Suarez DF, Tomassini-Fernandini JC, Cuevas A, Rosario-Berrios AN, Nuñez-Medina HJ, Padilla-Arroyo D, Rivera N, Liriano J, Vega-Roman RK, Renta JY, Melin K, Duconge J. Clinical Relevant Polymorphisms Affecting Clopidogrel Pharmacokinetics and Pharmacodynamics: Insights from the Puerto Rico Newborn Screening Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1115. [PMID: 29848980 PMCID: PMC6025039 DOI: 10.3390/ijerph15061115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/16/2018] [Accepted: 05/28/2018] [Indexed: 12/19/2022]
Abstract
Background: Variations in several clopidogrel-pharmacogenes have been linked to clopidogrel response variability and clinical outcomes. We aimed to determine the frequency distribution of major polymorphisms on CYP2C19, PON1, ABCB1 and P2RY12 pharmacogenes in Puerto Ricans. Methods: This was a cross-sectional, population-based study of 200 unrelated "Guthrie" cards specimens from newborns registered in the Puerto Rican newborn screening program (PRNSP) between 2004 and 2014. Taqman® SNP assay techniques were used for genotyping. Results: Minor allele frequencies (MAF) were 46% for PON1 (rs662), 41% for ABCB1 (rs1045642), 14% for CYP2C19*17, 13% for CYP2C19*2, 12% for P2RY12-H2 and 0.3% for CYP2C19*4. No carriers of the CYP2C19*3 variants were detected. All alleles and genotype proportions were found to be in Hardy⁻Weinberg equilibrium (HWE). Overall, there were no significant differences between MAFs of these variants in Puerto Ricans and the general population (n = 453) of the 1000 Genome project, except when comparisons to each individual parental group were performed (i.e., Africans, Europeans and East-Asians; p < 0.05). As expected, the prevalence of these markers in Puerto Ricans most resembled those in the 181 subjects from reference populations of the Americas. Conclusions: These prevalence data provide a necessary groundwork for future clinical studies of clopidogrel pharmacogenetics in Caribbean Hispanics.
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Affiliation(s)
- Dagmar F Hernandez-Suarez
- Division of Cardiovascular Medicine, School of Medicine, University of Puerto Rico Medicine Sciences Campus, P.O. Box 365067, San Juan, PR 00936-5067, USA.
| | | | - Angelica Cuevas
- Department of Biology, Natural Sciences, University of Puerto Rico Rio Piedras Campus, San Juan, PR 00931, USA.
| | - Anyelis N Rosario-Berrios
- Department of Biology, Natural Sciences, University of Puerto Rico Rio Piedras Campus, San Juan, PR 00931, USA.
| | - Héctor J Nuñez-Medina
- Division of Cardiovascular Medicine, School of Medicine, University of Puerto Rico Medicine Sciences Campus, P.O. Box 365067, San Juan, PR 00936-5067, USA.
| | - Dariana Padilla-Arroyo
- Pharmaceutical Sciences Department, University of Puerto Rico Medical Sciences Campus, San Juan, PR 00936, USA.
| | - Nannette Rivera
- Department of Biology, Natural Sciences, University of Puerto Rico Rio Piedras Campus, San Juan, PR 00931, USA.
| | - Jennifer Liriano
- Department of Biology, Natural Sciences, University of Puerto Rico Rio Piedras Campus, San Juan, PR 00931, USA.
| | - Rocio K Vega-Roman
- Department of Biology, Natural Sciences, University of Puerto Rico Bayamon Campus, Bayamon, PR 00959, USA.
| | - Jessicca Y Renta
- Department of Biochemistry, University of Puerto Rico Medical Sciences Campus, San Juan, PR 00936, USA.
| | - Kyle Melin
- Department of Pharmacy Practice, University of Puerto Rico Medical Sciences Campus, San Juan, PR 00936, USA.
| | - Jorge Duconge
- Pharmaceutical Sciences Department, University of Puerto Rico Medical Sciences Campus, San Juan, PR 00936, USA.
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Zeb I, Krim N, Bella J. Role of CYP2C19 genotype testing in clinical use of clopidogrel: is it really useful? Expert Rev Cardiovasc Ther 2018; 16:369-377. [PMID: 29589775 DOI: 10.1080/14779072.2018.1459186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
INTRODUCTION P2Y12 inhibitors, including clopidogrel have become an integral part of treatment for patients receiving coronary stent placement as a result of stable coronary artery disease or acute coronary syndromes (ACS) and also for medically managed ACS patients. Areas covered: Clopidogrel efficacy can be significantly modified by polymorphism of CYP2C19 genotype (more than 25 allelic variants) involved in its metabolism that can adversely affect its anti-platelet activity. As a result, a substantial number of patients (20-30%) with ACS show an inadequate response to clopidogrel despite a standardized dosing regimen. Experts commentary: Currently, there is conflicting evidence in regards to the use of CYP2C19 genotyping to identify poor responders to clopidogrel in clinical practice. ACC/AHA guidelines do not recommend routine use of CYP2C19 in clinical practice, whereas Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines recommend its use to identify poor/intermediate metabolizers of Clopidogrel and suggest alternative P2Y12 inhibitors among ACS patients undergoing percutaneous coronary intervention. This review article will look at the literature evidence for the use of CYP2C19 genotyping in clinical practice.
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Affiliation(s)
- Irfan Zeb
- a Division of Cardiology, Department of Medicine , Bronxcare Health System , Bronx , NY , USA.,b Division of Cardiology, Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Nassim Krim
- a Division of Cardiology, Department of Medicine , Bronxcare Health System , Bronx , NY , USA.,b Division of Cardiology, Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Jonathan Bella
- a Division of Cardiology, Department of Medicine , Bronxcare Health System , Bronx , NY , USA.,b Division of Cardiology, Department of Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA.,c Division of Cardiology, Department of Medicine , Weill Cornell Medicine , New York , NY , USA
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18
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Roullet S, Labrouche S, Carrie C, Auque H, Berard X, Freyburger G. Multiplate ® evaluation of acetylsalicylic acid efficacy in carotid surgery: routine and genetic influencing factors. J Thromb Haemost 2018; 16:583-591. [PMID: 29314596 DOI: 10.1111/jth.13943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Indexed: 11/30/2022]
Abstract
Essentials Acetylsalicylic acid (ASA) is prescribed to patients scheduled for carotid endarterectomy (CEA). We measured ASA efficacy during CEA by Multiplate® and searched for influencing factors. Most patients scheduled for CEA and treated by ASA are sensitive to this therapy. Influencing genomic factors are involved in ASA metabolism and in platelet function modulations. SUMMARY Background Acetylsalicylic acid (ASA) is recommended before, during and after carotid endarterectomy (CEA). The efficacy of ASA is influenced by numerous biological and genotypic factors. Objectives To determine the biological efficacy of ASA by using the Multiplate® method, and to explore the biological parameters and genomic factors influencing this efficacy. Methods This descriptive cross-sectional study included all patients scheduled for CEA between January 2012 and April 2013. Multiplate® tests were performed at day 0 and day 30. A set of 66 single-nucleotide polymorphisms (SNPs) from 38 genes or DNA regions were selected and studied along with phenotypic parameters by the use of hierarchical clustering (HC) for multidimensional data management. Results Fifty-five patients receiving ASA were analyzed. Of the patients, 95% were found to be sensitive to ASA, with values under the threshold of normality (400 AU min-1 ). However, there were notable differences in residual aggregation among subjects over a wide range. HC revealed four subclusters comprising three categories of parameters: (i) routine and functional parameters - in ASA-treated patients, the ASPItest was highly linked to the ADPtest, to platelet count, and, to a lesser extent, to fibrinogen and hematocrit; (ii) polymorphisms in genes involved in ASA absorption and in the arachidonic acid pathway (ABCB1 and COX-1); and (iii) polymorphisms in genes modulating basal platelet function, i.e. TBXA2R, ADRA2A, PEAR1, ITGA2 and ITGB1. Conclusion Most patients treated with ASA before CEA were sensitive to it, according to Multiplate® ASPItest results. Genomic factors influencing this efficacy are SNPs involved in ASA absorption and metabolic pathway, and in modulations in basal platelet function.
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MESH Headings
- ATP Binding Cassette Transporter, Subfamily B/genetics
- Aged
- Aged, 80 and over
- Aspirin/therapeutic use
- Carotid Arteries/surgery
- Cluster Analysis
- Cyclooxygenase 1/genetics
- Endarterectomy, Carotid/methods
- Female
- Fibrinogen/analysis
- Genomics
- Hematocrit
- Humans
- Integrin alpha2/genetics
- Integrin beta1/genetics
- Male
- Middle Aged
- Platelet Aggregation/drug effects
- Platelet Aggregation Inhibitors/therapeutic use
- Platelet Count
- Platelet Function Tests
- Polymorphism, Genetic
- Polymorphism, Single Nucleotide
- Receptors, Adrenergic, alpha-2/genetics
- Receptors, Cell Surface/genetics
- Receptors, Thromboxane A2, Prostaglandin H2/genetics
- Sequence Analysis, DNA
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Affiliation(s)
- S Roullet
- CHU Bordeaux, Service Anesthésie Réanimation I, Bordeaux, France
- Université Bordeaux, Inserm U 12-11, Bordeaux, France
| | - S Labrouche
- CHU Bordeaux, Laboratoire Hématologie-PTRR, Bordeaux, France
- Université Bordeaux, Inserm U 10-34, Bordeaux, France
| | - C Carrie
- CHU Bordeaux, Service Anesthésie Réanimation I, Bordeaux, France
| | - H Auque
- CHU Bordeaux, Service de chirurgie vasculaire, Bordeaux, France
| | - X Berard
- CHU Bordeaux, Service de chirurgie vasculaire, Bordeaux, France
- Université Bordeaux, Inserm U 10-26, Bordeaux, France
| | - G Freyburger
- CHU Bordeaux, Laboratoire Hématologie-PTRR, Bordeaux, France
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Moon JY, Franchi F, Rollini F, Rios JRR, Kureti M, Cavallari LH, Angiolillo DJ. Role of genetic testing in patients undergoing percutaneous coronary intervention. Expert Rev Clin Pharmacol 2018; 11:151-164. [PMID: 28689434 PMCID: PMC5771818 DOI: 10.1080/17512433.2017.1353909] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Variability in individual response profiles to antiplatelet therapy, in particular clopidogrel, is a well-established phenomenon. Genetic variations of the cytochrome P450 (CYP) 2C19 enzyme, a key determinant in clopidogrel metabolism, have been associated with clopidogrel response profiles. Moreover, the presence of a CYP2C19 loss-of-function allele is associated with an increased risk of atherothrombotic events among clopidogrel-treated patients undergoing percutaneous coronary interventions (PCI), prompting studies evaluating the use of genetic tests to identify patients who may be potential candidates for alternative platelet P2Y12 receptor inhibiting therapies (prasugrel or ticagrelor). Areas covered: The present manuscript provides an overview of genetic factors associated with response profiles to platelet P2Y12 receptor inhibitors and their clinical implications, as well as the most recent developments and future considerations on the role of genetic testing in patients undergoing PCI. Expert commentary: The availability of more user-friendly genetic tests has contributed towards the development of many ongoing clinical trials and personalized medicine programs for patients undergoing PCI. Results of pilot investigations have shown promising results, which however need to be confirmed in larger-scale studies to support the routine use of genetic testing as a strategy to personalize antiplatelet therapy and improve clinical outcomes.
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Affiliation(s)
- Jae Youn Moon
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Francesco Franchi
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Fabiana Rollini
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Jose R. Rivas Rios
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Megha Kureti
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Larisa H. Cavallari
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Center for Pharmacogenomics, University of Florida, Gainesville, FL, USA
- Clinical & Translational Science Institute, University of Florida, Gainesville, FL, USA
| | - Dominick J. Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
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Kupka D, Sibbing D. P2Y 12 receptor inhibitors: an evolution in drug design to prevent arterial thrombosis. Expert Opin Drug Metab Toxicol 2018; 14:303-315. [PMID: 29338536 DOI: 10.1080/17425255.2018.1428557] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION P2Y12 inhibitors are a critical component of dual antiplatelet therapy (DAPT), which is the superior strategy to prevent arterialthrombosis in patients with acute coronary syndromes (ACS) and undergoing stent implantation.. Areas covered: Basic science articles, clinical studies, and reviews from 1992-2017 were searched using Pubmed library to collet impactful literature. After an introduction to the purinergic receptor biology, this review summarizes current knowledge on P2Y12 receptor inhibitors. Furthermore, we describe the subsequent improvements of next-generation P2Y12 receptor inhibitors facing the ambivalent problem of bleeding events versus prevention of arterial thrombosis in a variety of clinical settings. Therefore, we summarize data from relevant preclinical and clinical trials of currently approved P2Y12 receptor inhibitors (clopidogrel, prasugrel, ticagrelor, cangrelor) and provide strategies of drug switching and management of bleeding events. Expert opinion: An enormous amount of pharmacologic and clinical data is available for the application of P2Y12 receptor inhibitors. Today prasugrel, ticagrelor and clopidogrel are the standard of care drugs during dual antiplatelet therapy for ACS patients, but have considerable rates of bleeding. Recent and future clinical trials will provide evidence for subsequent escalation and de-escalation strategies of P2Y12 receptor inhibition. These data may pave the way for an evidence-based, individualized P2Y12 receptor inhibitor therapy.
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Affiliation(s)
- Danny Kupka
- a Department of Cardiology , LMU München , Munich , Germany.,b DZHK (German Centre for Cardiovascular Research) , Munich Heart Alliance , Munich , Germany
| | - Dirk Sibbing
- a Department of Cardiology , LMU München , Munich , Germany.,b DZHK (German Centre for Cardiovascular Research) , Munich Heart Alliance , Munich , Germany
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21
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Angiolillo DJ, Ferreiro JL, Jakubowski JA, Winters KJ, Effron MB, Duvvuru S, Costigan TM, Sundseth SS, Walker JR, Saucedo JF, Kleiman NS, Varenhorst C, Braun OÖ. Enhanced active metabolite generation and platelet inhibition with prasugrel compared to clopidogrel regardless of genotype in thienopyridine metabolic pathways. Thromb Haemost 2017; 110:1223-31. [DOI: 10.1160/th13-03-0263] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 08/09/2013] [Indexed: 12/29/2022]
Abstract
SummaryClopidogrel response varies according to the presence of genetic polymorphisms. The CYP2C19*2 allele has been associated with impaired response; conflicting results have been reported for CYP2C19*17, ABCB1, and PON1 genotypes. We assessed the impact of CYP2C19, PON1, and ABCB1 polymorphisms on clopidogrel and prasugrel pharmacodynamic (PD) and pharmacokinetic (PK) parameters. Aspirin-treated patients (N=194) with coronary artery disease from two independent, prospective, randomised, multi-centre studies comparing clopidogrel (75 mg) and prasugrel (10 mg) were genotyped and classified by predicted CYP2C19 metaboliser phenotype (ultra metabolisers [UM] = *17 carriers; extensive metabolisers [EM] = *1/1 homozygotes; reduced metabolisers [RM] = *2 carriers). ABCB1 T/T and C/T polymorphisms and PON1 A/A, A/G and G/G polymorphisms were also genotyped. PD parameters were assessed using VerifyNow® P2Y12 and vasodilator stimulated phosphoprotein (VASP) expressed as platelet reactivity index (PRI) after 14 days of maintenance dosing. Clopidogrel and prasugrel active metabolite (AM) exposure was calculated in a cohort of 96 patients. For clopidogrel, genetic variants in CYP2C19, but not ABCB1 or PON1, affected PK and PD. For prasugrel, none of the measured genetic variants affected PK or PD. Compared with clopidogrel, platelet inhibition with prasugrel was greater even in the CYP2C19 UM phenotype. Prasugrel generated more AM and achieved greater platelet inhibition than clopidogrel irrespective of CYP2C19, ABCB1, and PON1 polymorphisms. The lack of effect from genetic variants on prasugrel AM generation or antiplatelet activity is consistent with previous studies in healthy volunteers and is consistent with improved efficacy in acute coronary syndrome patients managed with percutaneous coronary intervention.
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22
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Fefer P, Matetzky S. The genetic basis of platelet responsiveness to clopidogrel. Thromb Haemost 2017; 106:203-10. [DOI: 10.1160/th11-04-0228] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 06/30/2011] [Indexed: 01/06/2023]
Abstract
SummaryClopidogrel reduces ischaemic complications in a wide range of patients with coronary artery disease. However, there is much inter-individual variation in clopidogrel-induced platelet inhibition, and a substantial proportion of patients will exhibit non-responsiveness to clopidogrel. Multiple studies have demonstrated an association between the presence of genetic polymorphisms associated with suboptimal clopidogrel-active metabolite generation, decreased platelet responsiveness, and adverse clinical outcomes. However, it is not clear to what extent the genetic polymorphisms account for the observed variability in response to clopidogrel. In this review we provide a critical summary of the available evidence linking genetic factors with response to clopidogrel, and discuss the clinical implications of this association.
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Berinstein E, Levy A. Recent developments and future directions for the use of pharmacogenomics in cardiovascular disease treatments. Expert Opin Drug Metab Toxicol 2017; 13:973-983. [PMID: 28792790 DOI: 10.1080/17425255.2017.1363887] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Cardiovascular disease is still the leading cause of death worldwide. There are many environmental and genetic factors that play a role in the development of cardiovascular disease. The treatment of cardiovascular disease is beginning to move in the direction of personalized medicine by using biomarkers from the patient's genome to design more effective treatment plans. Pharmacogenomics have already uncovered many links between genetic variation and response of many different drugs. Areas covered: This article will focus on the main polymorphisms that impact the risk of adverse effects and response efficacy of statins, clopidogrel, aspirin, β-blockers, warfarin dalcetrapib and vitamin E. The genes discussed include SLCO1B1, ABCB1, CYP3A4, CYP3A5, CYP2C19, PTGS1, PTGS2, ADRB1, ADCY9, CYP2C19, PON1, CES1, PEAR1, GPIIIa, CYP2D6, CKORC1, CYP2C9 and Hp. Expert opinion: Although there are some convincing results that have already been incorporated in the labelling treatment guidelines, most gene-drug relationships have been inconsistent. A better understanding of the relationships between genetic factors and drug response will provide more opportunities for personalized diagnosis and treatment of cardiovascular disease.
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Affiliation(s)
- Elliot Berinstein
- a Technion Faculty of Medicine , Technion Israel Institute of Technology , Haifa , Israel
| | - Andrew Levy
- a Technion Faculty of Medicine , Technion Israel Institute of Technology , Haifa , Israel
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24
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Tatarunas V, Kupstyte N, Zaliunas R, Giedraitiene A, Lesauskaite V. The impact of clinical and genetic factors on ticagrelor and clopidogrel antiplatelet therapy. Pharmacogenomics 2017; 18:969-979. [DOI: 10.2217/pgs-2017-0070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To determine clinically significant factors which may alter the effect of dual antiplatelet therapy with aspirin and ticagrelor or clopidogrel in patients who had undergone percutaneous coronary intervention and stent implantation. Materials & methods: The study included 378 patients. All the patients had undergone percutaneous coronary intervention and stent implantation. Platelet aggregation and genotyping for CYP2C19 *2 (rs4244285) and CYP4F2 (rs2108622, rs1558139, rs3093135 and rs2074902) was performed. Results: Significantly lower platelet aggregation values (%agr) were detected in ticagrelor users who carried CYP4F2 rs3093135 TT variant (14.67 ± 5.07%agr) versus AA (22.88 ± 6.30%agr), p = 0.0004, or AT (20.56 ± 6.51%agr), p = 0.0126. Conclusion: Results of the current study showed that CYP4F2 rs3093135 TT variant carriers had a higher antiplatelet effect of ticagrelor, and more frequently had nonprocedural bleeding during ticagrelor therapy, as compared with AA and AT variant carriers.
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Affiliation(s)
- Vacis Tatarunas
- Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu 17, Kaunas LT 50009, Lithuania
| | - Nora Kupstyte
- Department of Cardiology, Lithuanian University of Health Sciences, Eiveniu 2, Kaunas LT 50009, Lithuania
| | - Remigijus Zaliunas
- Department of Cardiology, Lithuanian University of Health Sciences, Eiveniu 2, Kaunas LT 50009, Lithuania
| | - Agne Giedraitiene
- Department of Microbiology, Lithuanian University of Health Sciences, A. Mickeviciaus 9, Kaunas LT 44307, Lithuania
| | - Vaiva Lesauskaite
- Institute of Cardiology, Lithuanian University of Health Sciences, Sukileliu 17, Kaunas LT 50009, Lithuania
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O'connor CT, Kiernan TJ, Yan BP. The genetic basis of antiplatelet and anticoagulant therapy: A pharmacogenetic review of newer antiplatelets (clopidogrel, prasugrel and ticagrelor) and anticoagulants (dabigatran, rivaroxaban, apixaban and edoxaban). Expert Opin Drug Metab Toxicol 2017; 13:725-739. [PMID: 28571507 DOI: 10.1080/17425255.2017.1338274] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The study of pharmacogenomics presents the possibility of individualised optimisation of drug therapy tailored to each patients' unique physiological traits. Both antiplatelet and anticoagulant drugs play a key role in the management of cardiovascular disease. Despite their importance, there is a substantial volume of literature to suggest marked person-to-person variability in their effect. Areas covered: This article reviews the data available for the genetic cause for this inter-patient variability of antiplatelet and anticoagulant drugs. The genetic basis for traditional antiplatelets (i.e. aspirin) is compared with the newly available antiplatelet medicines (clopidogrel, prasugrel and ticagrelor). Similarly, the pharmacogenetics of warfarin is compared with the newer direct oral anticoagulants (DOACs) in detail. Expert Opinion: We identify strengths and weaknesses in the research thus far; including shortcomings in trial design and a review of newer analytical techniques. The direction of this research and its real-world implications are discussed.
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Affiliation(s)
- Cormac T O'connor
- a Cardiology Department , University Hospital Limerick , Limerick , Ireland
| | - Thomas J Kiernan
- a Cardiology Department , University Hospital Limerick , Limerick , Ireland
| | - Bryan P Yan
- b Division of Cardiology, Department of Medicine and Therapeutics , The Chinese University of Hong Kong, Prince of Wales Hospital , Hong Kong SAR , China
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26
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Olędzki S, Kornacewicz-Jach Z, Safranow K, Kiedrowicz R, Gawrońska-Szklarz B, Jastrzębska M, Gorący J. Variability of platelet response to clopidogrel is not related to adverse cardiovascular events in patients with stable coronary artery disease undergoing percutaneous coronary intervention. Eur J Clin Pharmacol 2017; 73:1085-1094. [PMID: 28589365 DOI: 10.1007/s00228-017-2271-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/22/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Antiplatelet response to clopidogrel and its influence upon the risk of cardiovascular adverse events among patients with stable coronary artery disease undergoing percutaneous coronary intervention (PCI) has not been investigated fully. METHODS Two hundred eleven patients treated with aspirin and clopidogrel were included in the study. Immediately before PCI, residual platelet reactivity testing with impedance aggregometry assay and a single-nucleotide polymorphism genotyping analysis targeting variants of CYP2C19, ABCB1, and PON1 genes was performed. After the index PCI, the patients were screened for cardiovascular events 6 months following bare-metal stent implantation or 12 months following drug-eluting stent implantation. RESULTS High on-treatment platelet reactivity (HTPR) was observed in 19.43% individuals and low-TPR (LTPR) in 26.54%. In multivariate analysis, HTPR was significantly (p < 0.05) associated with a history of diabetes, higher systolic blood pressure, and platelet count comparing to that of other patients. LTPR was significantly associated with no history of hypertension, younger age, lower platelet count, absence of the CYP2C19*2 variant, and lower CRP plasma level. Overall, cardiac adverse events were noted in 14.23% patients. Survival analysis with the Cox proportional hazard model showed no influence of residual platelet reactivity during clopidogrel therapy upon both ischemic and hemorrhagic events. However, significant predictors for composite of major adverse cardiac events and hospitalization for cardiovascular causes were identified (the higher CCS class prior to coronary intervention and the higher creatinine serum concentration). CONCLUSIONS The platelet response to clopidogrel has no impact upon post-procedural adverse events at mid-term follow-up in patients with stable CAD undergoing PCI. This finding suggests that routine platelet reactivity testing is not beneficial in this group of patients.
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Affiliation(s)
- Szymon Olędzki
- Department of Cardiology, Pomeranian Medical University, 72 Powstancow Wlkp Str, 70-111, Szczecin, Poland.
| | - Zdzisława Kornacewicz-Jach
- Department of Cardiology, Pomeranian Medical University, 72 Powstancow Wlkp Str, 70-111, Szczecin, Poland
| | - Krzysztof Safranow
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, 72 Powstancow Wlkp Str, 70-111, Szczecin, Poland
| | - Radosław Kiedrowicz
- Department of Cardiology, Pomeranian Medical University, 72 Powstancow Wlkp Str, 70-111, Szczecin, Poland
| | - Barbara Gawrońska-Szklarz
- Department of Pharmacokinetics and Therapeutic Drug Monitoring, 72 Powstancow Wlkp Str, 70-111, Szczecin, Poland
| | - Maria Jastrzębska
- Department of Laboratory Diagnostics and Molecular Medicine, 72 Powstancow Wlkp Str, 70-111, Szczecin, Poland
| | - Jarosław Gorący
- Department of Cardiology, Pomeranian Medical University, 72 Powstancow Wlkp Str, 70-111, Szczecin, Poland
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Saydam F, Değirmenci İ, Birdane A, Özdemir M, Ulus T, Özbayer C, Çolak E, Ata N, Güneş HV. The CYP2C19*2 and CYP2C19*17 Polymorphisms play a Vital Role in Clopidogrel Responsiveness after Percutaneous Coronary Intervention: A Pharmacogenomics Study. Basic Clin Pharmacol Toxicol 2017; 121:29-36. [PMID: 28135763 DOI: 10.1111/bcpt.12763] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 01/23/2017] [Indexed: 12/26/2022]
Abstract
Clopidogrel inhibits platelet activation and aggregation by blocking the P2Y12 receptor. Dual antiplatelet therapy with clopidogrel and aspirin is recommended treatment by current guidelines for patients undergoing percutaneous interventions. Recurrent ischaemic cardiac events after this treatment showed lack of clopidogrel responsiveness. We aimed to investigate the most noticeable variants in the genes involved in clopidogrel pharmacokinetics and pharmacodynamics. A total of 347 Turkish patients who underwent percutaneous coronary interventions with stent implantation were included in our study. Platelet reactivity (PRU) and % inhibition were measured with VerifyNow P2Y12 assay in blood samples collected from patients who took a standard dose of clopidogrel (75 mg/day) for at least 7 days. The variants in the CYP2C19, CYP3A4, CYP2B6, ABCB1, ITGB3 and PON1 genes were genotyped using the Sequenom MassARRAY system. When grouped, the patients with PRU values >208 as non-responsiveness to clopidogrel therapy; 104 (30%) patients were non-responders and 243 (70%) patients were responders. A significant association was found between the CYP2C19*2 (G636A) polymorphism and non-responsiveness to clopidogrel therapy (p < 0.001). An allele frequency of this single nucleotide polymorphism was high in non-responders; its odds ratio was 2.92 compared with G allele (p < 0.001). PRU values of CT genotypes were lower (p = 0.029) and % inhibition values of CT genotypes were higher (p = 0.008) compared with CC genotypes for the CYP2C19*17 (C806T) polymorphism. None of the other genetic variants were found to be statistically associated with non-responsiveness to clopidogrel and antiplatelet activity. Our findings suggest that the CYP2C19*2 polymorphism is associated with non-responsiveness to clopidogrel therapy and the CYP2C19*17 polymorphism enhances antiplatelet activity of clopidogrel. Depending on haplotypes of these two polymorphisms, clopidogrel-treated patients can be protected or not from stent thrombosis and ischaemic events.
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Affiliation(s)
- Faruk Saydam
- Department of Medical Biology and Genetics, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - İrfan Değirmenci
- Department of Medical Biology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Alparslan Birdane
- Department of Cardiology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Mahmut Özdemir
- Department of Pharmacology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Taner Ulus
- Department of Cardiology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Cansu Özbayer
- Department of Midwifery, School of Health, Kütahya Dumlupınar University, Kütahya, Turkey
| | - Ertuğrul Çolak
- Department of Biostatistics, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Necmi Ata
- Department of Cardiology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
| | - Hasan Veysi Güneş
- Department of Medical Biology, Faculty of Medicine, Eskişehir Osmangazi University, Eskişehir, Turkey
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28
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CYP2C19 but not CYP2B6, CYP3A4, CYP3A5, ABCB1, PON1 or P2Y12 genetic polymorphism impacts antiplatelet response after clopidogrel in Koreans. Blood Coagul Fibrinolysis 2017; 28:56-61. [PMID: 27380588 DOI: 10.1097/mbc.0000000000000536] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Clopidogrel response variability (CRV) is well documented, and may affect clinical outcomes. Impact of genetic polymorphisms is important for assessing and predicting CRV. The extensive evidence indicates the importance of CYP2C19 variants in reducing efficacy of clopidogrel. This study defined the impact of numerous genetic polymorphisms on CRV before and after percutaneous coronary interventions (PCI) exclusively in a Korean cohort assuming less genetic variability noise. One hundred and thirty-six patients of Korean origin undergoing PCI were included. Platelet reactivity was measured by VerifyNow assay before and after PCI. Genetic polymorphism of seven single nucleotides of CYP2B6, CYP2C19, CYP3A4, CYP3A5, ABCB1, PON1, and P2Y12 were evaluated and matched with platelet reactivity. Carriers of at least one CYP2C19*2 or *3 allele uniformly exhibited higher platelet reactivity compared to 0-carrier pre-PCI (odds ratio 3.1, 95% confidence interval 1.4-6.9, P < 0.01) and post-PCI (odds ratio 3.4, 95% confidence interval 1.7-6.8, P < 0.001). The carriers of other gene allele variants lack uniformed impact on CRV. The Korean carriers of CYP2C19*2 or *3 allele are linked to CRV, whereas CYP2B6, CYP3A4, CYP3A5, ABCB1, PON1, and P2Y12 failed to predict CRV. The exact clinical utility of these findings is uncertain, and requires a large randomized national trial for proof of concept.
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29
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Marchini JFM, Pinto MR, Novaes GC, Badran AV, Pavão RB, Figueiredo GL, Lago IM, Lima-Filho MO, Lemos DC, Tonani M, Antloga CM, Oliveira L, Lorenzi JC, Marin-Neto JA. Decreased platelet responsiveness to clopidogrel correlates with CYP2C19 and PON1 polymorphisms in atherosclerotic patients. ACTA ACUST UNITED AC 2017; 50:e5660. [PMID: 28076455 PMCID: PMC5264542 DOI: 10.1590/1414-431x20165660] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 11/10/2016] [Indexed: 11/30/2022]
Abstract
Clopidogrel and aspirin are the most commonly used medications worldwide for dual
antiplatelet therapy after percutaneous coronary intervention. However, clopidogrel
hyporesponsiveness related to gene polymorphisms is a concern. Populations with
higher degrees of genetic admixture may have increased prevalence of clopidogrel
hyporesponsiveness. To assess this, we genotyped CYP2C19,
ABCB1, and PON1 in 187 patients who underwent
percutaneous coronary intervention. Race was self-defined by patients. We also
performed light transmission aggregometry with adenosine diphosphate (ADP) and
arachidonic acid during dual antiplatelet therapy. We found a significant difference
for presence of the CYP2C19*2 polymorphism between white and
non-white patients. Although 7% of patients had platelet resistance to clopidogrel,
this did not correlate with any of the tested genetic polymorphisms. We did not find
platelet resistance to aspirin in this cohort. Multivariate analysis showed that
patients with PON1 and CYP2C19 polymorphisms had
higher light transmission after ADP aggregometry than patients with native alleles.
There was no preponderance of any race in patients with higher light transmission
aggregometry. In brief, PON1 and CYP2C19
polymorphisms were associated with lower clopidogrel responsiveness in this sample.
Despite differences in CYP2C19 polymorphisms across white and
non-white patients, genetic admixture by itself was not able to identify clopidogrel
hyporesponsiveness.
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Affiliation(s)
- J F M Marchini
- Unidade de Hemodinâmica e Cardiologia Intervencionista, Divisão de Cardiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - M R Pinto
- Departamento de Odontologia, Universidade de Uberaba, Uberaba, MG, Brasil
| | - G C Novaes
- Unidade de Hemodinâmica e Cardiologia Intervencionista, Divisão de Cardiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - A V Badran
- Unidade de Hemodinâmica e Cardiologia Intervencionista, Divisão de Cardiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - R B Pavão
- Unidade de Hemodinâmica e Cardiologia Intervencionista, Divisão de Cardiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - G L Figueiredo
- Unidade de Hemodinâmica e Cardiologia Intervencionista, Divisão de Cardiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - I M Lago
- Unidade de Hemodinâmica e Cardiologia Intervencionista, Divisão de Cardiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - M O Lima-Filho
- Unidade de Hemodinâmica e Cardiologia Intervencionista, Divisão de Cardiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - D C Lemos
- Unidade de Hemodinâmica e Cardiologia Intervencionista, Divisão de Cardiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - M Tonani
- Unidade de Hemodinâmica e Cardiologia Intervencionista, Divisão de Cardiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - C M Antloga
- Unidade de Hemodinâmica e Cardiologia Intervencionista, Divisão de Cardiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - L Oliveira
- Divisão de Hematologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - J C Lorenzi
- Departamento de Genética, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - J A Marin-Neto
- Unidade de Hemodinâmica e Cardiologia Intervencionista, Divisão de Cardiologia, Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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30
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Yang HH, Chen Y, Gao CY. Associations ofP2Y12Rgene polymorphisms with susceptibility to coronary heart disease and clinical efficacy of antiplatelet treatment with clopidogrel. Cardiovasc Ther 2016; 34:460-467. [PMID: 27566695 DOI: 10.1111/1755-5922.12223] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Hong-Hui Yang
- Department of Cardiology; Henan Provincial People's Hospital; Zhengzhou Henan China
| | - Yan Chen
- Department of Cardiology; Henan Provincial People's Hospital; Zhengzhou Henan China
| | - Chuan-Yu Gao
- Department of Cardiology; Henan Provincial People's Hospital; Zhengzhou Henan China
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31
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Gan J, Ma S, Zhang D. Non-cytochrome P450-mediated bioactivation and its toxicological relevance. Drug Metab Rev 2016; 48:473-501. [DOI: 10.1080/03602532.2016.1225756] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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32
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Ma W, Liang Y, Zhu J, Chen T, Feng G, Yang Y, Liu X, Wang X. Relationship of paraoxonase-1 Q192R genotypes and in-stent restenosis and re-stenting in Chinese patients after coronary stenting. Atherosclerosis 2016; 251:305-310. [PMID: 27450784 DOI: 10.1016/j.atherosclerosis.2016.07.901] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/18/2016] [Accepted: 07/13/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS Asians have very different genotype distributions of cytochrome P450 2C19 (CYP2C19), ATP-binding cassette, sub-family B, member 1 (ABCB1), and paraoxonase-1 (PON1), in whom relevant studies based on large samples are scarce. The purpose of this study was to evaluate the effects of these genes on outcomes of in-stent restenosis and re-stenting in Chinese patients after coronary stenting. METHODS A total of 2569 acute coronary syndrome (ACS) patients were enrolled in a gene database study. Among the 1674 patients receiving coronary stenting, 504 patients performed repeated coronary angiography within the next year after discharge and were eligible to complete our final cohort. RESULTS The prevalence of the CYP2C19 loss-of-function carriers (had at least 1 allele of *2, *3 and *4) was considerable high (52.2%). During re-angiography, in-stent restenosis occurred in 106 (21.0%) out of the 504 patients; the mean restenosis degree was 71.3% and 152 (30.2%) patients received re-stenting treatment. In multivariate regression, only age and left ventricular ejection fraction (LVEF) were significantly associated with in-stent restenosis. As for predictors of re-stenting, multivariate regression identified variables of LVEF, coronary artery lesions, and PON1 Q192R genotype. Genotype RR of PON1 Q192R was an independent risk factor predicting re-stenting compared with genotypes of QQ and QR (OR 1.95, 95% CI 1.30-2.93, p = 0.001). The genotypes of CYP2C19, ABCB1 C3435T, and PON1 L55M showed no significant associations with in-stent restenosis or re-stenting. CONCLUSIONS Genotype RR of PON1 Q192R was an independent risk factor predicting re-stenting in Chinese ACS patients after coronary stenting.
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Affiliation(s)
- Wenfang Ma
- Emergency and Critical Care Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yan Liang
- Emergency and Critical Care Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
| | - Jun Zhu
- Emergency and Critical Care Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Tao Chen
- Emergency and Critical Care Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Guangxun Feng
- Emergency and Critical Care Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yanmin Yang
- Emergency and Critical Care Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Xin Liu
- Beijing Institute of Union of Hypertension, Beijing, People's Republic of China
| | - Xingyu Wang
- Beijing Institute of Union of Hypertension, Beijing, People's Republic of China
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Feng M, Sun T, Zhao Y, Zhang H. Detection of Serum Interleukin-6/10/18 Levels in Sepsis and Its Clinical Significance. J Clin Lab Anal 2016; 30:1037-1043. [PMID: 27184083 DOI: 10.1002/jcla.21977] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 03/04/2016] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To explore the clinical significance of serum levels of IL-6/10/18 in sepsis. METHODS Sixty-six patients with sepsis were selected to be the case group. Additionally, 42 healthy adults were selected to be the control group. ELISA was used to measure the serum levels of IL-6/10/18, and ROC was utilized to evaluate the diagnostic values of IL-6/10/18 in sepsis. RESULTS The heart rate, respiratory rate, WBC count and APACHE II score in the sepsis group were significantly higher than those in the control group, and these indexes were increased in turn in the mild sepsis group, severe sepsis group, and septic shock group (all P < 0.05 after correction). The serum IL-6/18 levels in sepsis patients were significantly higher than those in the control group, and both of the levels were increased in turn in the mild sepsis group, severe sepsis group, and septic shock group (both P < 0.05). However, no significant difference was found in serum IL-10 level between groups (P > 0.05). The cut-off points of IL-6 and IL-18 were 109.19 pg/ml (sensitivity: 94.4%; specificity: 83.3%) and 116.01 pg/ml (sensitivity: 77.8%; specificity: 83.3%), respectively. Serum IL-6 levels were positively correlated with the APACHE II score and heart rate (both P < 0.001). CONCLUSION Serum levels of IL-6/8 are up-regulated in sepsis patients. Additionally, IL-6 has a greater sensitivity than IL-18. Serum IL-6 levels were positively correlated with the APACHE II score and heart rate, indicating that IL-6 could be used as a potential biomarker for sepsis.
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Affiliation(s)
- Mingchen Feng
- Department of Intensive Medicine, Jining NO. 1 People's Hospital, Jining, China
| | - Tingting Sun
- Department of Operation Room, Jining NO.1 People's Hospital, Jining, China
| | - Yaxin Zhao
- Department of Pharmacy, Jining NO.1 People's Hospital, Jining, China
| | - Hui Zhang
- Department of Intensive Medicine, Jining NO. 1 People's Hospital, Jining, China.
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34
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Cytochrome allelic variants and clopidogrel metabolism in cardiovascular diseases therapy. Mol Biol Rep 2016; 43:473-84. [DOI: 10.1007/s11033-016-3983-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 04/04/2016] [Indexed: 01/18/2023]
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35
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PON1 Q192R genetic variant and response to clopidogrel and prasugrel: pharmacokinetics, pharmacodynamics, and a meta-analysis of clinical outcomes. J Thromb Thrombolysis 2015; 41:374-83. [DOI: 10.1007/s11239-015-1264-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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36
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Byrne RA, Joner M, Kastrati A. Stent thrombosis and restenosis: what have we learned and where are we going? The Andreas Grüntzig Lecture ESC 2014. Eur Heart J 2015; 36:3320-31. [PMID: 26417060 PMCID: PMC4677274 DOI: 10.1093/eurheartj/ehv511] [Citation(s) in RCA: 388] [Impact Index Per Article: 43.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 09/07/2015] [Indexed: 12/18/2022] Open
Abstract
Modern-day stenting procedures leverage advances in pharmacotherapy and device innovation. Patients treated with contemporary antiplatelet agents, peri-procedural antithrombin therapy and new-generation drug-eluting stents (DES) have excellent outcomes over the short to medium term. Indeed, coupled with the reducing costs of these devices in most countries there remain very few indications where patients should be denied treatment with standard-of-care DES therapy. The two major causes of stent failure are stent thrombosis (ST) and in-stent restenosis (ISR). The incidence of both has reduced considerably in recent years. Current clinical registries and randomized trials with broad inclusion criteria show rates of ST at or <1% after 1 year and ∼0.2-0.4% per year thereafter; rates of clinical ISR are 5% respectively. Angiographic surveillance studies in large cohorts show rates of angiographic ISR of ∼10% with new-generation DES. The advent of high-resolution intracoronary imaging has shown that in many cases of late stent failure neoatherosclerotic change within the stented segment represents a final common pathway for both thrombotic and restenotic events. In future, a better understanding of the pathogenesis of this process may translate into improved late outcomes. Moreover, the predominance of non-stent-related disease as a cause of subsequent myocardial infarction during follow-up highlights the importance of lifestyle and pharmacological interventions targeted at modification of the underlying disease process. Finally, although recent developments focus on strategies which circumvent the need for chronically indwelling stents--such as drug-coated balloons or fully bioresorbable stents-more data are needed before the wider use of these therapies can be advocated.
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Affiliation(s)
- Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, Munich, Germany
| | - Michael Joner
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, Munich, Germany
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, Munich, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
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Tatarunas V, Jankauskiene L, Kupstyte N, Skipskis V, Gustiene O, Grybauskas P, Lesauskaite V. The role of clinical parameters and of CYP2C19 G681 and CYP4F2 G1347A polymorphisms on platelet reactivity during dual antiplatelet therapy. Blood Coagul Fibrinolysis 2015; 25:369-74. [PMID: 24418943 DOI: 10.1097/mbc.0000000000000053] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Dual antiplatelet therapy with aspirin and clopidogrel is used to lower the risk of arterial thrombosis. However, this strategy is not always successful owing to high interindividual variability in response to antiplatelet therapy. To evaluate an impact of CYP2C19 G681A and CYP4F2 G1347A polymorphisms and clinical factors on dual antiplatelet effect of clopidogrel and aspirin. Totally 89 patients who continued dual aspirin and clopidogrel antiplatelet therapy for at least of 14 days were included into the further study. Test for platelet aggregation was performed according to the classical Born method. Genotyping of CYP2C19*2 and CYP2C19*3 and CYP4F2*3 was done by using commercial probes from Applied Biosystems (UK). Patient age, weight and body weight index did not correlate significantly with platelet aggregation level both induced by ADP and epinephrine (P > 0.05). Serum concentration of creatinine, diabetes, angiotensin II receptor blockers, B-blockers, statin or omeprazole use had no significant effect on platelet aggregation. The users of angiotensin-converting enzyme inhibitors had lower platelet aggregation levels with epinephrine vs. nonusers: 28.80 ± 13.25 vs. 51.15 ± 23.50, P < 0.03, respectively. Platelet aggregation with ADP was higher in CYP2C19*1*2 genotype carriers than in CYP2C19*1*1 carriers (P = 0.01). Platelet aggregation with epinephrine was higher in CYP4F2 GA genotype carriers than in GG (P = 0.04) or AA (P = 0.01) carriers. Our study confirms that CYP2C19 G681A genotype has an impact on antiplatelet effect of clopidogrel. The novelty is that the platelet aggregation after induction with epinephrine is influenced by CYP4F2 G1347A genotype.
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Affiliation(s)
- Vacis Tatarunas
- aInstitute of Cardiology bDepartment of Internal Diseases cDepartment of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Jiang XL, Samant S, Lesko LJ, Schmidt S. Clinical pharmacokinetics and pharmacodynamics of clopidogrel. Clin Pharmacokinet 2015; 54:147-66. [PMID: 25559342 DOI: 10.1007/s40262-014-0230-6] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Acute coronary syndromes (ACS) remain life-threatening disorders, which are associated with high morbidity and mortality. Dual antiplatelet therapy with aspirin and clopidogrel has been shown to reduce cardiovascular events in patients with ACS. However, there is substantial inter-individual variability in the response to clopidogrel treatment, in addition to prolonged recovery of platelet reactivity as a result of irreversible binding to P2Y12 receptors. This high inter-individual variability in treatment response has primarily been associated with genetic polymorphisms in the genes encoding for cytochrome (CYP) 2C19, which affect the pharmacokinetics of clopidogrel. While the US Food and Drug Administration has issued a boxed warning for CYP2C19 poor metabolizers because of potentially reduced efficacy in these patients, results from multivariate analyses suggest that additional factors, including age, sex, obesity, concurrent diseases and drug-drug interactions, may all contribute to the overall between-subject variability in treatment response. However, the extent to which each of these factors contributes to the overall variability, and how they are interrelated, is currently unclear. The objective of this review article is to provide a comprehensive update on the different factors that influence the pharmacokinetics and pharmacodynamics of clopidogrel and how they mechanistically contribute to inter-individual differences in the response to clopidogrel treatment.
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Affiliation(s)
- Xi-Ling Jiang
- Department of Pharmaceutics, Center for Pharmacometrics and Systems Pharmacology, University of Florida at Lake Nona (Orlando), 6550 Sanger Road, Room 467, Orlando, FL, 32827, USA
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Nakkam N, Tiamkao S, Kanjanawart S, Tiamkao S, Vannaprasaht S, Tassaneeyakul W, Tassaneeyakul W. The impact of genetic polymorphisms of drug metabolizing enzymes on the pharmacodynamics of clopidogrel under steady state conditions. Drug Metab Pharmacokinet 2015; 30:295-304. [DOI: 10.1016/j.dmpk.2015.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 04/28/2015] [Accepted: 05/09/2015] [Indexed: 10/23/2022]
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Yang Y, Lewis JP, Hulot JS, Scott SA. The pharmacogenetic control of antiplatelet response: candidate genes and CYP2C19. Expert Opin Drug Metab Toxicol 2015; 11:1599-617. [PMID: 26173871 DOI: 10.1517/17425255.2015.1068757] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Aspirin, clopidogrel, prasugrel and ticagrelor are antiplatelet agents for the prevention of ischemic events in patients with acute coronary syndromes (ACS), percutaneous coronary intervention (PCI) and other indications. Variability in response is observed to different degrees with these agents, which can translate to increased risks for adverse cardiovascular events. As such, potential pharmacogenetic determinants of antiplatelet pharmacokinetics, pharmacodynamics and clinical outcomes have been actively studied. AREAS COVERED This article provides an overview of the available antiplatelet pharmacogenetics literature. Evidence supporting the significance of candidate genes and their potential influence on antiplatelet response and clinical outcomes are summarized and evaluated. Additional focus is directed at CYP2C19 and clopidogrel response, including the availability of clinical testing and genotype-directed antiplatelet therapy. EXPERT OPINION The reported aspirin response candidate genes have not been adequately replicated and few candidate genes have thus far been implicated in prasugrel or ticagrelor response. However, abundant data support the clinical validity of CYP2C19 and clopidogrel response variability among ACS/PCI patients. Although limited prospective trial data are available to support the utility of routine CYP2C19 testing, the increased risks for reduced clopidogrel efficacy among ACS/PCI patients that carry CYP2C19 loss-of-function alleles should be considered when genotype results are available.
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Affiliation(s)
- Yao Yang
- a 1 Icahn School of Medicine at Mount Sinai, Department of Genetics and Genomic Sciences , New York, NY, USA +1 212 241 3780 ; +1 212 241 0139 ;
| | - Joshua P Lewis
- b 2 University of Maryland School of Medicine, Division of Endocrinology, Diabetes and Nutrition, and Program for Personalized and Genomic Medicine , Baltimore, MD, USA
| | - Jean-Sébastien Hulot
- c 3 Icahn School of Medicine at Mount Sinai, Cardiovascular Research Center , New York, NY, USA.,d 4 Sorbonne Universités, UPMC Univ Paris 06, INSERM , UMR_S 1166 ICAN, F-75005 Paris, France
| | - Stuart A Scott
- a 1 Icahn School of Medicine at Mount Sinai, Department of Genetics and Genomic Sciences , New York, NY, USA +1 212 241 3780 ; +1 212 241 0139 ;
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Yu XY, Chen JY, Zheng ZW, Wu H, Li LW, Zhang ZW, Chen ZH, Lin QX, Han YL, Zhong SL. Plasma miR-126 as a potential marker predicting major adverse cardiac events in dual antiplatelet-treated patients after percutaneous coronary intervention. EUROINTERVENTION 2015; 9:546-54. [PMID: 24058072 DOI: 10.4244/eijv9i5a90] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Antiplatelet treatment can cause a change in plasma levels of platelet microRNAs (miRNAs). However, it is not clear whether the plasma level of platelet miRNAs can predict clinical outcomes of antiplatelet treatment. The present study aimed to evaluate the association of plasma miR-16, miR%E2%80%9121, miR-126, miR-26b, and miR-223 with the risk of clinical outcomes in dual antiplatelet-treated patients after percutaneous coronary intervention (PCI). METHODS AND RESULTS A total of 491 Han Chinese patients who had received PCI and dual antiplatelet therapy were sequentially recruited to the study and followed for up to one year. Plasma concentrations of five candidate miRNAs early the next morning after PCI were determined by quantitative reverse transcription PCR. The effect of the plasma miRNA level on major adverse cardiovascular events (MACE) within one year and bleeding within six months were assessed. We found that a higher plasma miR-126 level was significantly associated with a higher risk in terms of time-to-MACE. When compared with the plasma miR-126 level in the first three quartiles, the hazard ratio (HR) for the plasma miR-126 level in the fourth quartile was 2.61 (95% CI: 1.32-5.18, p=0.006). Multivariable Cox regression analysis showed that diabetes mellitus, ejection fraction, hypertension and a higher plasma miR-126 level were independent risk factors for MACE. Plasma miR-223 level was not an independent predictive marker for MACE. There was no significant association between the level of five plasma miRNAs and bleeding events during six-month follow-up. CONCLUSIONS Based on these results, we suggest that plasma miR-126 could be a potential marker for predicting major adverse cardiac events in patients after PCI.
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Affiliation(s)
- Xi-Yong Yu
- Medical Research Center of Guangdong General Hospital, Guangzhou, Guangdong, China
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Affiliation(s)
- Thomas M Polasek
- Department of Clinical PharmacologyFlinders University and Flinders Medical Centre Adelaide SA 5042
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Liu CC, Zhang ZY. Impact of proton pump inhibitors on clinical outcomes in patients receiving clopidogrel and possible mechanisms. Shijie Huaren Xiaohua Zazhi 2015; 23:1447-1453. [DOI: 10.11569/wcjd.v23.i9.1447] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Clopidogrel, a second generation thienopyridine antiplatelet agent, is increasingly prescribed for patients with recent stroke, myocardial infarction, acute coronary syndrome, or those undergoing percutaneous coronary intervention. Current consensus recommends co-administration of proton pump inhibitors (PPIs) during clopidogrel therapy to reduce the risk of gastrointestinal complications. However, studies have demonstrated a significant reduction in platelet inhibition when PPIs therapy is administered to subjects on clopidogrel, which thus increases the risk of adverse cardiovascular events. There have been recent concerns about the safety of PPIs though the postulated link between PPI use and adverse cardiovascular events has not been well established since evidence from randomized controlled trials does not support such an association. Here, we review the impact of PPIs on clinical outcomes in patients on clopidogrel and the possible mechanisms.
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Zhang L, Yang J, Zhu X, Wang X, Peng L, Li X, Cheng P, Yin T. Effect of high-dose clopidogrel according to CYP2C19*2 genotype in patients undergoing percutaneous coronary intervention– a systematic review and meta-analysis. Thromb Res 2015; 135:449-58. [DOI: 10.1016/j.thromres.2014.12.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 11/02/2014] [Accepted: 12/03/2014] [Indexed: 11/29/2022]
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Abstract
The emergence of personalized medicine mandates a complete understating of DNA sequence variation that modulates drug response. Initial forays have been made in the cardiac arena, yet much remains to be elucidated in the pharmacogenetics of cardiac drugs. Most progress has been made in describing DNA sequence variation related to the anticoagulant warfarin and the antiplatelet drug clopidogrel. This includes a description of DNA sequence variation that underlies pharmacokinetic and pharmacodynamic variability, the impact of such variation on predicting hard outcomes, and the ability of genotype-guided prescription to facilitate rapid titration to a therapeutic range while avoiding unnecessary high plasma levels. Nuanced prescription will require a complete inventory of DNA sequence variants that underlie drug-related side effects.
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Bonello L, Gaubert M, Laine M, Barragan P, Pinto J, Iloud A, Lemesle G, Roch A, Dignat-George F, Paganelli F, Kerbaul F, Thuny F. Clopidogrel Response Variability: Etiology and Clinical Relevance. CURRENT CARDIOVASCULAR RISK REPORTS 2015. [DOI: 10.1007/s12170-015-0437-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Personalized antiplatelet therapy with P2Y12 receptor inhibitors: benefits and pitfalls. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2015; 11:259-80. [PMID: 26677375 PMCID: PMC4679793 DOI: 10.5114/pwki.2015.55596] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 11/05/2015] [Accepted: 11/05/2015] [Indexed: 02/07/2023] Open
Abstract
Antiplatelet therapy with P2Y12 receptor inhibitors has become the cornerstone of medical treatment in patients with acute coronary syndrome, after percutaneous coronary intervention and in secondary prevention of atherothrombotic events. Clopidogrel used to be the most broadly prescribed P2Y12 receptor inhibitor with undisputable benefits especially in combination with aspirin, but a considerable number of clopidogrel-treated patients experience adverse thrombotic events in whom insufficient P2Y12-inhibition and a consequential high on-treatment platelet reactivity is a common finding. This clinically relevant limitation of clopidogrel has driven the increased use of new antiplatelet agents. Prasugrel (a third generation thienopyridine) and ticagrelor (a cyclopentyl-triazolo-pyrimidine) feature more potent and predictable P2Y12-inhibition compared to clopidogrel, which translates into improved ischemic outcomes. However, excessive platelet inhibition and consequential low on-treatment platelet reactivity comes at the price of increased risk of major bleeding. The majority of randomized clinical trials failed to demonstrate improved clinical outcomes with platelet function testing and tailored antiplatelet therapy, but results of all recent trials of potent antiplatelets and prolonged antiplatelet durations point towards a need for individualized antiplatelet approach in order to decrease thrombotic events without increasing bleeding. This review focuses on potential strategies for personalizing antiplatelet treatment.
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Wang XQ, Shen CL, Wang BN, Huang XH, Hu ZL, Li J. Genetic polymorphisms of CYP2C19 2 and ABCB1 C3435T affect the pharmacokinetic and pharmacodynamic responses to clopidogrel in 401 patients with acute coronary syndrome. Gene 2014; 558:200-7. [PMID: 25542807 DOI: 10.1016/j.gene.2014.12.051] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 12/04/2014] [Accepted: 12/20/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUNDS AND OBJECTIVES Clopidogrel, an inhibitor of platelet ADP P2Y12 receptors, plays an important role in the prevention of stent thrombosis. However, some patients do not attain adequate antiplatelet effects. Studies have shown that the genetic variation in CYP2C19*2 is associated with an impaired response to clopidogrel. This study was designed to investigate the genetic variants of 21 genes involving in the absorption, metabolism, and pharmacodynamics of clopidogrel. The effects of these genes on the plasma level of clopidogrel and its metabolites (active clopi-H4 and inactive CLPM) and platelet reactivity were also studied. METHODS AND RESULTS 401 acute coronary syndrome (ACS) patients received either a 300 mg loading dose following 75 mg maintenance dose daily or a 75mg maintenance dose daily of clopidogrel. The inhibition of platelets was assessed using light transmittance aggregometry. Plasma concentrations of clopidogrel as well as its active (clopi-H4) and inactive (CLPM) metabolites were measured using HPLC-MS-MS method. Among 21 genes, the carriers of CYP2C19*2 were associated with lower exposure to its active (clopi-H4) and inactive (CLPM) metabolites (both P<0.05 vs. non-carriers) and thus decreased platelet inhibition (P<0.05 vs. non-carriers). Notably, the carriers of ABCB1 C3435T were associated with lower levels of plasma clopidogrel and its active (clopi-H4) and inactive (CLPM) metabolites (all P<0.05 vs. non-carriers) which also correlated with subsequently decreased platelet inhibition (P<0.05 vs. non-carriers). There were no obvious effects of other studied genes on clopidogrel. CONCLUSIONS CYP2C19*2 is a determinant for the formation of the active metabolite of clopidogrel and its antiplatelet effects. Meanwhile, ABCB1 C3435T plays an important role in intestinal absorption of clopidogrel which further affects the exposure to the active metabolite of clopidogrel and platelet aggregation.
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Affiliation(s)
- Xia-Qin Wang
- Division of Cardiology, The First Affiliated Hospital, Anhui Medical University, Hefei 230032, China; Division of Cardiology, The Fourth Affiliated Hospital, Anhui Medical University, Hefei 230032, China
| | - Chen-Lin Shen
- Center of Drug Metabolism and Pharmacokinetics, School of Pharmacy, Anhui Medical University, Hefei 230032, China; Department of Basic and Clinical Pharmacology, School of Pharmacy, Anhui Medical University, Hefei 230032, China
| | - Bang-Ning Wang
- Division of Cardiology, The First Affiliated Hospital, Anhui Medical University, Hefei 230032, China.
| | - Xiao-Hui Huang
- Center of Drug Metabolism and Pharmacokinetics, School of Pharmacy, Anhui Medical University, Hefei 230032, China; Department of Basic and Clinical Pharmacology, School of Pharmacy, Anhui Medical University, Hefei 230032, China.
| | - Zhang-le Hu
- Division of Cardiology, The Second Affiliated Hospital, Anhui Medical University, Hefei 230032, China
| | - Jun Li
- Institute for Liver Diseases of Anhui Medical University (AMU), Anhui Key Laboratory of Bioactivity of Natural Products, School of Pharmacy, Anhui Medical University, Hefei 230032, China
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Trenk D, Hochholzer W. Genetics of platelet inhibitor treatment. Br J Clin Pharmacol 2014; 77:642-53. [PMID: 23981082 DOI: 10.1111/bcp.12230] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 08/13/2013] [Indexed: 01/10/2023] Open
Abstract
Dual antiplatelet therapy with aspirin and a P2Y12 receptor antagonist is the standard of care in patients undergoing percutaneous coronary intervention (PCI) and in patients with acute coronary syndromes (ACS) because this regimen has markedly decreased the rate of cardiovascular events. The substantial variability in pharmacodynamic response as well as the moderate antiplatelet efficacy of clopidogrel has raised major concerns, since high on-clopidogrel platelet reactivity has consistently been associated with increased risk for ischaemic events in PCI patients. Baseline demographic and clinical variables contributing to the observed variability have been identified. Besides this, research within the past decade has focused on the impact of genetic polymorphisms encoding transport systems or enzymes involved in the absorption and metabolism of these drugs. Loss-of-function polymorphisms in CYP2C19 are the strongest individual variables affecting pharmacokinetics and antiplatelet response to clopidogrel, but explain no more than 5 to 12% of the variability in adenosine diphosphate-induced platelet aggregation on clopidogrel. No genetic variables contributing to clinical outcomes of patients treated with the newer P2Y12 receptor antagonists, prasugrel or ticagrelor, have been identified so far. This review aims to provide an update on the current status of genotype-based personalized therapy with clopidogrel.
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Affiliation(s)
- Dietmar Trenk
- Klinik für Kardiologie und Angiologie II, Universitäts-Herzzentrum Freiburg-Bad Krozingen, Bad Krozingen, Germany
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Sabatine MS, Mega JL. Pharmacogenomics of antiplatelet drugs. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2014; 2014:343-347. [PMID: 25696877 DOI: 10.1182/asheducation-2014.1.343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Clopidogrel, a platelet P2Y12 inhibitor, is one of the most widely prescribed drugs in cardiovascular medicine because it reduces ischemic and thrombotic complications. It is a prodrug requiring biotransformation into the active metabolite by the hepatic cytochrome 450 system, especially the CYP2C19 enzyme. Candidate gene studies and genome-wide association studies have identified loss-of-function CYP2C19 variants to be associated with a diminished pharmacologic response. Specifically, compared with noncarriers, carriers of at least one copy of a loss-of-function CYP2C19 allele have ∼30% lower levels of active clopidogrel metabolite and ∼25% relatively less platelet inhibition with clopidogrel. Moreover, in patients treated with clopidogrel predominantly for percutaneous coronary intervention, carriers of 1 or 2 CYP2C19 loss-of-function alleles are at increased risk for major adverse cardiovascular outcomes, with an ∼1.5-fold increase in the risk of cardiovascular death, myocardial infarction, or stroke as well as an ∼3-fold increase in risk for stent thrombosis. Tripling the dose of clopidogrel in carriers of a CYP2C19 loss-of-function allele can achieve on-treatment platelet reactivity comparable to that seen with the standard 75 mg dose in wild-type individuals, but the impact on clinical outcomes remains unknown. Alternatively, 2 third-generation P2Y12 inhibitors are available: prasugrel and ticagrelor. These drugs are superior to clopidogrel in reducing ischemic outcomes and are unaffected by CYP2C19 loss-of-function alleles.
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Affiliation(s)
- Marc S Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Jessica L Mega
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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