Clinical Relevant Polymorphisms Affecting Clopidogrel Pharmacokinetics and Pharmacodynamics: Insights from the Puerto Rico Newborn Screening Program

Hernández-Suárez, Dagmar F.; Tomassini-Fernandini, Jonnalie C.; Cuevas, Angélica; Rosario-Berrios, Anyelis N.; Nuñez-Medina, Héctor J.; Padilla-Arroyo, Dariana; Rivera, Nannette; Liriano, Jennifer; Vega-Roman, Rocio K.; Renta, Jessicca Y.; Melin, Kyle; Duconge, Jorge

doi:10.3390/ijerph15061115

Cited by 4 publications

(1 citation statement)

References 37 publications

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“…Despite the introduction of prasugrel, ticagrelor, and cangrelor (newer P2Y12 ADP blockers), clopidogrel remains the most commonly used drug for secondary prevention for patients with cardiovascular disease who susceptible to thrombotic and ischemic complications due to its low cost and availability (Hernandez-Suarez et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

The potential interaction of statins and clopidogrel in patients undergoing percutaneous coronary intervention

al.¹

2021

Int. j. adv. appl. sci.

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Clopidogrel is widely used for patients with acute coronary syndrome. It is a pro-drug that requires bioactivation by several cytochrome P450 (CYP) enzymes, mainly CYP3A4, CYP2C9, and CYP2C19 enzymes. Lipophilic statins such as atorvastatin are used concomitantly with clopidogrel due to their beneficial effects on morbidity and mortality in the arena of cardiovascular diseases. However, lipophilic statins are eliminated by CYP3A4 and undergo the same metabolic pathway of clopidogrel. Hence, statins may compete with clopidogrel for CYP3A4 enzyme resulting in diminishing the anti-platelet effect of clopidogrel. We aimed to study the impact of concomitant statin therapy on clopidogrel efficacy in patients undergoing percutaneous coronary intervention (PCI) evaluate the clinical relevance of potential clopidogrel and statins interaction and association between use of statins and risk of future adverse cardiac events. A cross-sectional retrospective cohort study was conducted on 50 patients attending Prince Sultan Cardiac Center for follow-up after PCI. All patients discharged on clopidogrel, aspirin, and atorvastatin were later divided into two groups according to the occurrence of MACEs. Statistical analysis was performed by Statistical Package for the Social Science (SPSS; V. 21.0). This study was on adult and geriatric males (72%)and female (28%). More than half of them exhibited major adverse cardiac events (MACEs), of which 48% exhibited it after 4 to 6 months from PCI indexing followed by 1 to 3 months (34%), and the least after 7 to 9 months. A significant association arises between gender and MACEs (P=0.042). Moreover, the average age was significantly higher in patients who experience MACEs compared to others (62.7 vs. 55.4, P=0.037). Regarding comorbidities, hypertension increased in patients with MACEs (73.1%) compared to those without MACEs (45.8%). The average duration of taking clopidogrel was significantly shorter in patients with MACEs compared to those who did not (3.42 vs. 5.54 months, P<0.001). According to the findings of this study, atorvastatin affects clopidogrel efficacy in patients undergoing PCI.

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Section: Introductionmentioning

confidence: 99%

The potential interaction of statins and clopidogrel in patients undergoing percutaneous coronary intervention

al.¹

2021

Int. j. adv. appl. sci.

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Assessment of the clinical utility of pharmacogenetic guidance in a comprehensive medication management service

Rodríguez-Escudero

Cedeño

Rodríguez-Nazario

et al. 2020

J Am Coll Clin Pharm

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Introduction Pharmacists are poised to be the health care professionals best suited to provide medication‐related consults and services based on a patient's genetics. Despite its potential benefits, the implementation of pharmacogenetic (PGx) testing into primary clinical settings has been slow among medically underserved populations. To our knowledge, this is the first time that PGx‐driven recommendations have been incorporated into a Comprehensive Medication Management (CMM) service in a Hispanic population. Objectives The aim of this study is to evaluate the clinical utility of adding PGx guidance into pharmacist‐driven CMM. Methods This is a pre‐ and post‐interventional design study. Patients were recruited from a psychologist's clinic. A total of 24 patients had a face‐to‐face interview with a pharmacist to complete a CMM, Personal Medication Record, and Medication‐Related Action Plan (MAP) blind to PGx findings. Collected buccal DNA samples were genotyped using drug‐metabolizing enzymes and transporters (DMET) Plus Array. Results The pharmacist generated new MAPs for each patient based on PGx results. Genetic variants that could potentially affect the safety and effectiveness of at least one drug in the pharmacotherapy were identified in 96% of patients, for whom the pharmacist changed the initial recommendations. Polymorphisms in genes encoding for isoenzymes CYP2D6, CYP2C19, and CYP2C9 were identified in 83%, 52%, and 41% of patients, respectively. Pharmacists performing CMM identified 22 additional medication problems after PGx determinations. Moreover, they agreed with the clinical utility of PGx in the studied sample based on perceived value of adding PGx to traditional CMM and its utility in the decision‐making process of pharmacists. Conclusions The study confirmed the critical role to be played by pharmacists in facilitating the clinical usage of relevant genetic information to optimize drug therapy decisions as well as their involvement on many levels of these multidisciplinary implementation efforts, including championing and leading PGx‐guided CMM services.

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Pharmacogenomics in Latin American Populations

et al. 2019

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Clinical Relevant Polymorphisms Affecting Clopidogrel Pharmacokinetics and Pharmacodynamics: Insights from the Puerto Rico Newborn Screening Program

Cited by 4 publications

References 37 publications

The potential interaction of statins and clopidogrel in patients undergoing percutaneous coronary intervention

The potential interaction of statins and clopidogrel in patients undergoing percutaneous coronary intervention

Assessment of the clinical utility of pharmacogenetic guidance in a comprehensive medication management service

Pharmacogenomics in Latin American Populations

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