Genotype-Guided Antiplatelet Therapy Post-PCI May Be Beneficial

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Patients without a loss-of-function allele and loss-of-function allele carriers prescribed alternative therapy had no difference in MACE.
Patients without a loss-of-function allele and loss-of-function allele carriers prescribed alternative therapy had no difference in MACE.

HealthDay News — Patients with a CYP2C19 loss-of-function allele have increased risk of major adverse cardiovascular events (MACE) with clopidogrel vs alternative antiplatelet therapy after percutaneous coronary intervention (PCI), according to a study published in JACC: Cardiovascular Interventions.

Larisa H. Cavallari, PharmD, from the University of Florida in Gainesville, and colleagues examined outcomes following clinical implementation of CYP2C19 genotype-guided antiplatelet therapy after PCI. The authors compared MACE within 12 months of PCI for patients with a loss-of-function allele prescribed clopidogrel vs alternative therapy.

The researchers found that 31.5% of the 1815 patients had a loss-of-function allele. Patients with a loss-of-function allele prescribed clopidogrel had a significantly higher risk for MACE vs those prescribed alternative therapy (23.4 vs 8.7 per 100 patient-years; adjusted hazard ratio, 2.26; 95% confidence interval, 1.18 to 4.32; P =.013). Among the 1210 patients with an acute coronary syndrome at the time of PCI, the results were similar (adjusted hazard ratio, 2.87; 95% confidence interval, 1.35 to 6.09; P =.013). Patients without a loss-of-function allele and loss-of-function allele carriers prescribed alternative therapy had no difference in MACE (adjusted hazard ratio, 1.14; 95% confidence interval, 0.69 to 1.88; P =.6).

"A future randomized study of genotype-guided antiplatelet therapy may be of value," the authors write.

Two authors disclosed ties to the pharmaceutical industry.

Reference

Cavallari LH, Lee CR, Beitelshees AL, et al. Multisite investigation of outcomes with implementation of CYP2C19 genotype-guided antiplatelet therapy after percutaneous coronary intervention. JACC Cardiovasc Interv. 2017 Oct 25. pii: S1936-8798(17)31499-1.

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