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.
The authors report a case of multiple pulmonary varices, a rare disease characterized by aneurysmatic venous dilatations, which can be present at any age and without gender predominance, occurring in isolation or associated with obstruction of the pulmonary veins. This condition usually manifests as a lung mass with variable clinical consequences.
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