CYP2C19 and Nongenetic Factors Predict Poor Responsiveness to Clopidogrel Loading dose after Coronary Stent Implantation

Abstract

Prediction of responsiveness after clopidogrel loading dose may substantially be improved by adding CYP2C19*2 genotype to nongenetic risk factors.

Association betweenCYP2C19Polymorphisms and Outcomes in Cerebral Endovascular Therapy

“…Compared with CYP2C19*17, CYP2C19*2 and CYP2C19*3 are well-documented as hypofunctioning alleles in healthy subjects and patients with coronary artery and cerebrovascular diseases. 9,12,[22][23][24] These alleles have also been reported to be significantly associated with subacute stent thrombosis and myocardial infarction following percutaneous coronary intervention. 8,25 This correlation is understood to be a leading cause for increased risk of ischemic complications.…”

Pre-Procedural Platelet Reactivity After Clopidogrel Loading in Korean Patients Undergoing Scheduled Percutaneous Coronary Intervention

“…Among the various genetic variants, the enzymatic activity of the CYP system has played an important role in the pharmacokinetics of various drugs. Geisler et al reported that responsiveness after a clopidogrel LD may be predicted by clinical factors and CYP2C19 genotyping 15) . Compared to clinical factors, the CYP2C19 polymorphism has been found to play an essential role in responsiveness to clopidogrel.…”

“…Although non-genetic clinical factors may influence the antiplatelet response to clopidogrel, the hepatic cytochrome P-450 (CYP) 2C19 polymorphism has demonstrated the greatest contribution to the clopidogrel response 15,16) . Because the CYP2C19 variant allele ( 2 or 3) is more frequently identified in the Korean population than in Caucasian cohorts 16,17) , pre-procedural platelet reactivity (PR) and the rate of high post-treatment platelet reactivity (HPPR) may be greater in Korean patients than in Caucasian; however, pre-procedural PR after a 300-mg LD of clopidogrel has not been established in largescale Korean patients treated with scheduled PCI.…”

Individual Antiplatelet Therapy in Patients With Atherosclerosis of Lower Extremities: Myth or Reality?

“…Необходимость лабораторно-го мониторинга и индивидуального подхода к антиагре-гантной терапии обсуждается давно. Отдельные авторы представляют свой положительный опыт по примене-нию различных лабораторных методов, в том числе генетического тестирования аллельных вариантов цитохрома CYP2C19, в оценке и прогнозе остаточной реактивности тромбоцитов на фоне лечения антиагре-гантами, а также алгоритмы к индивидуальному подбору режима (вид лекарственного препарата, сочетание пре-паратов, доза) антиагрегантной терапии [12][13][14]. Однако одно из последних масштабных исследований, посвя-щенных лабораторному мониторингу антиагрегантов, ANTARCTIC не подтвердило большую эффективность и безопасность лечения при таком подборе по сравнению со стандартным подходом, который не предполагает какого-либо лабораторного мониторинга и изменения на его основе режима антиагрегантной терапии [15].…”