Genetic Polymorphism of CYP2C19 and Inhibitory Effects of Ticagrelor and Clopidogrel Towards Post-Percutaneous Coronary Intervention (PCI) Platelet Aggregation in Patients with Acute Coronary Syndromes

Abstract

BackgroundThe aim of this study was to observe the effects of genetic polymorphism of CYP2C19 on inhibitory effects of ticagrelor (Tic) and clopidogrel (Clo) towards post-percutaneous coronary intervention (PCI) platelet aggregation (IPA) and major cardiovascular events (MACE) in patients with acute coronary syndromes (ACS).Material/MethodsFrom August 2013 to March 2014, 166 patients with ACS undergoing PCI were selected. The patients were randomly grouped into the Tic group and the Clo group. IPA was detected by thromboelastography (TEG) at 1 week after taking the pills. Genotyping of CYP2C19 gene was determined by analysis of gene sequence detection. Patients were followed up for 1 month and MACE was observed.ResultsThe total IPA in the Clo group was significantly increased compared with the Tic group (P<0.05). The IPAs in the 3 subgroups of Clo group were all significantly increased compared with the 3 subgroups of the Tic group (all P<0.05). MACE was not significantly different between Clo and Tic groups (P>0.05). MACE had no significant difference among the 3 subgroups of the Tic group (P>0.05). MACE in the low metabolism subgroup of the Clo group was significantly increased compared with the fast metabolism subgroup and middle metabolism subgroup of Clo group (P<0.05). MACE was not significant different between the fast metabolism subgroup and the middle metabolism subgroup of the Clo group (P>0.05). MACE in the low metabolism subgroup of the Tic group was significantly decreased compared with the low metabolism subgroup of the Clo group (P<0.05).ConclusionsTicagrelor has a better effect on inhibition platelet aggregation than Clopidogrel in ACS patients undergoing PCI.

Effect of CYP2C19 genetic polymorphism on the pharmacodynamics and clinical outcomes for patients treated with ticagrelor: a systematic review with qualitative and quantitative meta-analysis

“…Stimpfle et al found the platelet reactivity measured of adenosine diphosphate(ADP)-induced platelet aggregation in any LOF allele and no LOF allele of CYP2C19 genotype were 12.27 ± 11.4 and 11.21 ± 7.0 AU*min ( P > 0.05), respectively [ 26 ]. Dong et al found no significant differences on the risk of death, MI, revascularization, and stroke according to CYP2C19 genotype [ 27 ]. A study conducted by Wang et al found patients with acute minor stroke or TIA carrying any CYP2C19 LOF allele were associated with an increased risk of MACEs [ 11 ].…”

Efficacy and safety of clopidogrel versus prasugrel and ticagrelor for coronary artery disease treatment in patients with CYP2C19 LoF alleles: a systemic review and meta‐analysis

“…The characteristics of these studies are presented in Table 1. [20][21][22][23][24][25][26][27][28][29][30][31] A total of 12 studies encompassing 5829 CV patients with CYP2C19 LoF alleles were included in primary analysis. Patients, who were treated with clopidogrel at a dose range of 75-150 mg/day, prasugrel at a dose range of 3.75-10 mg/day, and ticagrelor at a dose of 180 mg/day, were diagnosed with stable CAD or acute coronary syndrome (ACS).…”

Initial evaluation of the relationship between CYP2C19 polymorphisms and platelet aggregation in patients with acute myocardial infraction in some hospitals in Hanoi

“…So với nhóm chuyển hóa giảm và kém, độ ngưng tập tiểu cầu của nhóm chuyển hóa bình thường có xu hướng thấp hơn (23,3 ±11,6% so với 27,8 ± 13,5%) phù hợp với nghiên cứu của Xinchun Yang và cộng sự [7]. Tuy nhiên sự khác biệt này chưa đạt mức ý nghĩa thống kê (p=0,169 >0,05).…”