Does CYP2C19 genotype-directed antiplatelet therapy improve outcomes in clopidogrel-treated patients with acute coronary syndromes undergoing percutaneous coronary intervention?
The 2013 CPIC guideline update provides refined recommendations for CYP2C19 genotype-directed antiplatelet therapy to reduce adverse cardiovascular events in clopidogrel-treated patients with ACS undergoing PCI.
Cytochrome P450 (CYP)2C19 catalyzes the bioactivation of the antiplatelet prodrug clopidogrel, and CYP2C19 loss-of-function alleles impair formation of active metabolites, resulting in reduced platelet inhibition. In addition, CYP2C19 loss-of-function alleles confer increased risks for serious adverse cardiovascular (CV) events among clopidogrel-treated patients with acute coronary syndromes (ACSs) undergoing percutaneous coronary intervention (PCI). Guideline updates include emphasis on appropriate indication for CYP2C19 genotype-directed antiplatelet therapy, refined recommendations for specific CYP2C19 alleles, and additional evidence from an expanded literature review (updates at http://www.pharmgkb.org).
Scott et al. (Wed,) studied this question.
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