Variability in on-treatment platelet reactivity explained by CYP2C19*2 genotype is modest in clopidogrel pretreated patients undergoing coronary stenting

Bouman, H. J.; Harmsze, Ankie M; Werkum, Jochem W. van; Breet, Nicoline J.; Bergmeijer, Thomas O.; Cate, Hugo Ten; Hackeng, Christian M.; Deneer, Vera H.M.; Berg, Jurriën Ten

doi:10.1136/hrt.2010.220509

Cited by 79 publications

(58 citation statements)

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“…However, a study from the Netherlands of 1069 clopidogrel-pretreated patients undergoing elective PCI found that loss-of-function CYP2C19 carrier status explained only part of the variability in platelet reactivity (13.0e20.6%), depending on the test used. 37 One approach to modifying high on-treatment platelet reactivity in carriers of loss-of-function CYP2C19 variants is to use antiplatelet drugs metabolised by different pathways, and this was confirmed by investigators from Korea in a substudy of the CILON-T randomised trial. 38 In patients with loss-of-function CYP2C19 variants who were randomised to dual antiplatelet therapy plus cilostazol, a selective phosphodiesterase-3 inhibitor, on-treatment platelet reactivity was significantly reduced compared with patients who received only aspirin and clopidogrel.…”

Section: Antiplatelet Therapiesdwhat's New?mentioning

confidence: 87%

Almanac 2012: Interventional cardiology

Meier

2013

Revista Portuguesa de Cardiologia (English Edition)

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The field of interventional cardiology continues to progress quickly. The efficacy of percutaneous interventions with newer generation drug-eluting stents has advanced a lot over the last decade. This improvement in stent performance has broadened the level of indication towards more complex interventions such as left main and multivessel PCI. Major improvements continue in the field of medical co-therapy such as antiplatelet therapies (bivalirudin, prasugrel, ticagrelor) and this will further improve outcomes of PCI. The same is true for intravascular imaging such as ultrasound IVUS and optical coherence tomography OCT. However, interventional cardiology has become a rather broad field, also including alcohol septal ablation for hypertrophic obstructive cardiomyopathy, etc. At the moment, the fastest growing area is the structural interventions, especially for aortic valve stenosis (transcatheter aortic valve implantation TAVI) and for mitral regurgitation (mitral clipping). This review covers recent advances in all these different fields of interventional cardiology. PERCUTANEOUS CORONARY INTERVENTION VERSUS MEDICAL TREATMENTPercutaneous coronary intervention (PCI) has guideline recommendations for treatment of ST elevation and non-ST elevation myocardial infarction (MI). 1 However, its role in stable coronary disease has been the subject of reappraisal following publication of the COURAGE trial, which showed that, in patients receiving optimal medical therapy, PCI does not improve cardiovascular outcomes, while incremental benefits for quality of life disappear by 36 months. A more recent meta-analysis of eight trials of optimal medical therapy versus PCI involving 7229 patients bears out the COURAGE conclusions by showing no significant differences between the groups with regard to death (9.1% vs 8.9%), non-fatal MI (8.1% vs 8.9%), unplanned revascularisation (30.7% vs 21.4%) and persistent angina (33% vs 29%).4 Drug-eluting stents (DESs) were used in only a minority of these patients and may have reduced the need for further revascularisation while improving symptomatic responses. Nevertheless, the meta-analysis reinforces contemporary guideline advice for optimal medical treatment as the initial treatment for stable angina.

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Section: Antiplatelet Therapiesdwhat's New?mentioning

confidence: 87%

Almanac 2012: Interventional cardiology

Meier

2013

Revista Portuguesa de Cardiologia (English Edition)

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show abstract

“…However, a study from the Netherlands of 1069 clopidogrel-pretreated patients undergoing elective PCI found that loss-of-function CYP2C19 carrier status explained only part of the variability in platelet reactivity (13.0-20.6%), depending on the test used. 37 One approach to modifying high on-treatment platelet reactivity in carriers of loss-of-function CYP2C19 variants is to use antiplatelet drugs metabolised by different pathways, and this was confirmed by investigators from Korea in a substudy of the CILON-T randomised trial. 38 In patients with loss-of-function CYP2C19 vari ants who were randomised to dual antiplatelet therapy plus cilostazol, a selective phosphodiesterase-3 inhibitor, on-treatment platelet reactivity was significantly reduced compared with patients who received only aspirin and clopidogrel.…”

Section: Antiplatelet Therapies-what's New?mentioning

confidence: 87%

Almanac 2012: Cardiovascular risk scores: The national society journals present selected research that has driven recent advances in clinical cardiology

Meier¹

2013

Srce i krvni sudovi

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Almanah 2012 serijaPercutaneous coronary intervention versus medical treatment P ercutaneous coronary intervention (PCI) has guide line recommendations for treatment of ST elevation and non-ST elevation myocardial infarction (MI).1 However, its role in stable coronary disease has been the subject of reappraisal following publication of the COURAGE trial, which showed that, in patients receiving optimal medical therapy, PCI does not improve cardiovascular outcomes, while incremental benefits for quality of life disappear by 36 months.2 3 A more recent meta-analysis of eight trials of optimal medical therapy versus PCI involving 7229 patients bears out the COURAGE conclusions by showing no significant differences between the groups with regard to death (9.1% vs 8.9%), non-fatal MI (8.1% vs 8.9%), unplanned revascularisation (30.7% vs 21.4%) and persistent angina (33% vs 29%).4 Drug-eluting stents (DESs) were used in only a minority of these patients and may have reduced the need for further revascularisation while improving symptomatic responses. Nevertheless, the meta-analysis reinforces contemporary guideline advice for optimal medical treatment as the initial treatment for stable angina.5 Whether this will change current practice remains to be seen, but early signs are not encouraging. Thus a US registry analysis of patients undergoing PCI before (n=173416) and after (n=293 795) the COURAGE report showed no change in the proportions receiving optimal medical treatment (43.5% vs 44.7%). 6 PCI versus coronary bypass surgery

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“…In the POPULAR study, CYP2C19*2 genotype was associated with approximately 4-6% and clinical variables with 9-17% variability in on-treatment platelet reactivity as assessed by ADP-induced platelet aggregation and VerifyNow P2Y12 assay. In the latter study both CYP2C19*2 and clinical variables were together associated with 13-21% on-treatment platelet reactivity [37].…”

Section: Influence Of Cyp2c19 Polymorphisms On Clopidogrel Metabolismmentioning

confidence: 94%

Pharmacogenomics of Oral P2Y12 Receptor Blockers

Apte¹

2013

J Pharmacogenomics Pharmacoproteomics

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Variability in on-treatment platelet reactivity explained by CYP2C19*2 genotype is modest in clopidogrel pretreated patients undergoing coronary stenting

Abstract: The CYP2C192 loss-of-function polymorphism is associated with a more frequent occurrence of HPR. However, the part of the interindividual variability in on-treatment platelet reactivity explained by CYP2C192 genotype is modest.

Cited by 79 publications

References 13 publications

Almanac 2012: Interventional cardiology

Almanac 2012: Interventional cardiology

Almanac 2012: Cardiovascular risk scores: The national society journals present selected research that has driven recent advances in clinical cardiology

Pharmacogenomics of Oral P2Y12 Receptor Blockers

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Variability in on-treatment platelet reactivity explained by CYP2C19*2 genotype is modest in clopidogrel pretreated patients undergoing coronary stenting

Abstract: The CYP2C19*2 loss-of-function polymorphism is associated with a more frequent occurrence of HPR. However, the part of the interindividual variability in on-treatment platelet reactivity explained by CYP2C19*2 genotype is modest.

Cited by 79 publications

References 13 publications

Almanac 2012: Interventional cardiology

Almanac 2012: Interventional cardiology

Almanac 2012: Cardiovascular risk scores: The national society journals present selected research that has driven recent advances in clinical cardiology

Pharmacogenomics of Oral P2Y12 Receptor Blockers

Contact Info

Product

Resources

About

Abstract: The CYP2C192 loss-of-function polymorphism is associated with a more frequent occurrence of HPR. However, the part of the interindividual variability in on-treatment platelet reactivity explained by CYP2C192 genotype is modest.