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March 16, 2021Circulation Cardiovascular InterventionsOpen Access

Clopidogrel Versus Ticagrelor or Prasugrel After Primary Percutaneous Coronary Intervention According to CYP2C19 Genotype

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Why the study?

Does clopidogrel reduce bleeding without increasing thrombotic events compared to ticagrelor or prasugrel in primary PCI patients without a CYP2C19 loss-of-function allele?

Population

2,429 patients who underwent primary percutaneous coronary intervention with determined CYP2C19 *2, *3, and…

Comparison

Clopidogrel in patients not carrying a CYP2C19… vs Ticagrelor or prasugrel treatment irrespective…

Design

RCT

Follow-up

12 months

Authors

DCDaniel M.F. ClaassensTBThomas O. BergmeijerGVGerrit J.A. Vos

Discussion

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Overview

Supports clopidogrel de-escalation in non-LOF carriers post-primary PCI to reduce bleeding; extends CYP2C19-guided P2Y12 selection evidence.

Structured PICO

Does clopidogrel reduce bleeding without increasing thrombotic events compared to ticagrelor or prasugrel in primary PCI patients without a CYP2C19 loss-of-function allele?

P
Population
2,429 patients who underwent primary percutaneous coronary intervention (PCI) with determined CYP2C19 *2, *3, and *17 genotypes
I
Intervention
Clopidogrel in patients not carrying a CYP2C19 loss-of-function allele (Analysis 2) / Clopidogrel in CYP2C19 *17 allele carriers (Analysis 1)
C
Comparator
Ticagrelor or prasugrel treatment irrespective of CYP2C19 genotype (Analysis 2) / Clopidogrel in non-carriers of the *17 allele (Analysis 1)
O
Outcome
Thrombotic outcome (composite of cardiovascular death, myocardial infarction, stent thrombosis, and stroke) and bleeding outcome (PLATO major and minor bleeding) after 12 monthscomposite

In primary PCI patients without a CYP2C19 loss-of-function allele, clopidogrel reduces bleeding risk without increasing thrombotic risk compared to ticagrelor or prasugrel.

Cite This Study

Claassens et al. (2021) studied this question.

synapsesocial.com/papers/69a31653a60bae612d55e497https://doi.org/10.1161/circinterventions.120.009434
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