Impact of point-of-care testing for CYP2C19 on platelet inhibition in patients with acute coronary syndrome and early dual antiplatelet therapy in the emergency setting

Stimpfle, Fabian; Karathanos, Athanasios; Droppa, Michal; Metzger, Janina Christin; Rath, Dominik; Müller, Karin; Tavlaki, Elli; Schäffeler, Elke; Winter, Stefan; Schwab, Matthias; Gawaz, Meinrad; Geisler, Tobias

doi:10.1016/j.thromres.2014.05.006

Cited by 26 publications

(13 citation statements)

References 31 publications

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“…To date, only one FDA‐cleared rapid “point‐of‐care” test is available for CYP2C19 specifically, but the equipment must be used in a clinical laboratory given its high‐complexity testing status. This rapid CYP2C19 assay may be ideal in acute care settings (e.g., post percutaneous coronary intervention [PCI] patients with acute coronary syndrome [ACS] prescribed clopidogrel) where results are available within an hour …”

Section: Laboratory Logisticsmentioning

confidence: 99%

Pharmacogenomics Implementation: Considerations for Selecting a Reference Laboratory

Bell

Obeng

et al. 2017

Pharmacotherapy

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One of the initial steps for implementing pharmacogenomics into routine patient care is selecting an appropriate clinical laboratory to perform the testing. With the rapid advances in genotyping technologies, many clinical laboratories are now performing pharmacogenomic testing. Selection of a reference laboratory depends on whether a particular genotype assay is already performed by an internal health care organization laboratory or only available externally. Other factors for consideration are coverage of genomic variants important for the patient population, technical support, and cost. In some instances, the decision to select a particular reference laboratory may be the responsibility of the clinician who is recommending genomic interrogation. Only limited guidance is available that describes the laboratory characteristics to consider when selecting a reference laboratory. We provide practical considerations for selecting a clinical laboratory for pharmacogenomic testing broadly categorized into four domains: pharmacogene and variant selection; logistics; reporting of results; and test costs along with reimbursement.

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Section: Laboratory Logisticsmentioning

confidence: 99%

Pharmacogenomics Implementation: Considerations for Selecting a Reference Laboratory

Bell

Obeng

et al. 2017

Pharmacotherapy

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“…A rapid gene trial showed a successful validation and clinical application of point-of-care genetic testing in selecting effective treatment following PCI (Roberts et al, 2012). Stimpfle and his colleagues also demonstrated that CYP2C19 loss-of-function point-ofcare genotyping identified the CYP2C19*2 allele carriers and enabled those patients to be identified who did not respond well to conventional treatment and allowed effective treatment to be prescribed on the basis of the established genotype (Stimpfle et al, 2014). The method, which was used by our research group, allows a bedside identification of the patient's CYP2C19 genotype in an hour.…”

Section: Discussionmentioning

confidence: 92%

Bedside stratification of patients according to CYP2C19*2 genotype

Karaliūtė¹,

Gustienė²,

Kupstytė³

et al. 2018

biologija

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Objective. The task was to identify the defective CYP2C19*2 allele by using a novel fast-genotyping method in the patients having coronary artery disease who developed stent thrombosis or high on-treatment platelet reactivity.Materials and methods. A total of 35 patients were included in the study. All the patients were screened for CYP2C19*2 using Spartan RX CYP2C19 Assay Package.Results. CYP2C19*1*1 variant was found in 63%, *1*2 in 34%, *2*2 in 3% of patients. The distribution of genotypes was similar in men and women.Conclusions. By using the bedside technique, CYP2C19*2, which is responsible for a poorer effect of clopidogrel, might be identified in less than an hour.

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“…This might represent also a clinical scenario where the determination of these polymorphisms might help to take decisions in short periods of time. In this regard, pilot studies suggest that these determinations may help to identify patients who benefit from a second loading dose of clopidogrel or a more potent antiplatelet drug (38, 39). …”

Section: Discussionmentioning

confidence: 99%

Genotyping of six clopidogrel-metabolizing enzyme polymorphisms has a minor role in the assessment of platelet reactivity in patients with acute coronary syndrome

Lagunar

Sánchez²,

Conesa‐Zamora³

et al. 2017

Anatol J Cardiol

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Objective:To evaluate the contribution of six polymorphisms to the platelet reactivity in patients with acute coronary syndrome (ACS) treated with clopidogrel.Methods:Cross-sectional study of 278 consecutive patients with ACS. Detailed clinical information for each patient was collected and genotypes (CYP2C9*2, CYP2C9*3, CYP2C19*2, CYP2C19*17, CYP3A4*1B, and PON1-Q192R) were evaluated with TaqMan® and KASPar® assays. Platelet reactivity was measured with VerifyNow®.Results:Mean age of patients was 66±11 years and 182 (65.5%) patients presented ACS without ST-segment elevation. A total of 206 (74.1%) patients presented poor response to clopidogrel (PRC). CYP2C19*2 polymorphism (p=0.038) was associated with PRC in the univariate setting. In the multiple logistic regression analysis, the risk factors for PRC were the presence of CYP3A4*1B allele (odds ratio [OR] 4.03; 95% confidence interval [CI] 1.01–16.34), age (OR 1.43; 95% CI 1.03–2.00), and body mass index (OR 4.05; 95% CI 1.21–13.43), whereas elevated hemoglobin was a protective factor. Discrimination of PRC through the model that included the six polymorphisms added modest information to the model based on clinical variables (C statistic difference 3.9%).Conclusion:CYP3A4*1B allele may be an independent determinant of PRC in patients with ACS, although the variability in response to clopidogrel explained by the six polymorphisms is poor when compared to clinical variables. (Anatol J Cardiol 2017; 17: 303-12)

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Impact of point-of-care testing for CYP2C19 on platelet inhibition in patients with acute coronary syndrome and early dual antiplatelet therapy in the emergency setting

Cited by 26 publications

References 31 publications

Pharmacogenomics Implementation: Considerations for Selecting a Reference Laboratory

Pharmacogenomics Implementation: Considerations for Selecting a Reference Laboratory

Bedside stratification of patients according to CYP2C19*2 genotype

Genotyping of six clopidogrel-metabolizing enzyme polymorphisms has a minor role in the assessment of platelet reactivity in patients with acute coronary syndrome

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