C0221: Genotype CYP2C19 Effects on Therapeutic Response During Clopidogrel Treatment in Patients with Carotid Artery Stenosis

Backovic, Dusan; Kovac, M; Čalija, Branko; Strugarević, Evgenija; Radak, Djordje; Rakićević, Ljiljana; Kušić-Tišma, Jelena; Radojković, Dragica; Ignjatovic, S.

doi:10.1016/s0049-3848(14)50259-9

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“… 8 Furthermore, the CYP2C19*2 loss-of-function variant allele has a significant influence on clopidogrel response in patients with carotid artery stenosis who are undergoing endarterectomy. 9 CYP2C19 loss-of-function alleles (CYP2C19*2 and CYP2C19*3 alleles) were associated with a poor prognosis in patients undergoing clopidogrel therapy following a carotid artery stent placement in the Asiatic ethnic population. 10 CYP2C19 genetic profiles can influence amputation-free survival and all-cause mortality in patients with PAD who are administered only clopidogrel after endovascular therapy.…”

Section: Introductionmentioning

confidence: 99%

Clopidogrel Use and CYP2C19 Genotypes in Patients Undergoing Vascular Intervention Procedure: A Hospital-Based Study

Liao¹,

Hsiao²,

Lin³

et al. 2022

PGPM

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Purpose Clopidogrel is widely used in coronary artery, peripheral arterial, and cerebrovascular disease. We aimed to study the association of the CYP2C19 phenotype with cardiovascular outcomes and interventional procedures in a hospital-based population. Patients and Methods This cross-sectional, retrospective study enrolled patients with prior exposure to clopidogrel at the Taichung Veterans General Hospital (TCVGH) using data extracted from the Taiwan Precision Medicine Initiative (TPMI). Data on the CYP2C19 phenotype, drug-prescription profile, comorbidities, vascular intervention procedures, and hospitalization due to acute myocardial infarction (AMI) or stroke of clopidogrel users were analyzed. Results From the 32,728 patients in the TCVGH-TPMI cohort, we selected 2687 clopidogrel users. A total of 400 (14.9%) clopidogrel poor metabolizers (PMs), 1235 (46.0%) intermediate metabolizers (IMs), and 1052 (39.2%) extensive metabolizers (EMs) were identified. The predominant loss-of-function allele is *2. In 2687 patients with clopidogrel exposure, the CYP2C19 PM phenotype was unassociated with hospitalization due to AMI or stroke after adjusting for comorbidities and carotid angiographies. Among the 1554 clopidogrel users who underwent cardiovascular intervention, 193 (12.4%) received two or more types of interventional procedures. Compared with non-PMs, patients with the PM phenotype had a higher risk of multiple carotid interventions (OR: 3.13, 95% CI: 1.19–8.22). Conclusion In this hospital-wide cohort, 8.2% were clopidogrel users, of which 14.9% were CYP2C19 PMs. The result of this study does not support universal genotyping of CYP2C19 in all clopidogrel users to identify risks for stroke and AMI. CYP2C19 PMs are more likely to undergo multiple carotid interventions than non-PMs. Prospective studies to investigate the association of the CYP2C19 genotype and carotid interventions and outcomes are needed to validate our results.

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Section: Introductionmentioning

confidence: 99%