Key result
Clopidogrel in CYP2C19 loss-of-function carriers linked to ~178% higher post-PCI ischemic risk.
Why the study?
It was unknown whether clopidogrel use in CYP2C19 loss-of-function carriers with high bleeding risk contributes to adverse outcomes after PCI.
Does clopidogrel use increase ischemic events in CYP2C19 loss-of-function carriers with high bleeding risk after PCI compared to retained inhibitor action?
Observational (n=618)
No
Does clopidogrel use increase ischemic events in CYP2C19 loss-of-function carriers with high bleeding risk after PCI compared to retained inhibitor action?
Effect estimate: aHR 2.78 (95% CI 1.40-5.52)
Absolute Event Rate: 10.2% vs 3%
p-value: p=0.004
In patients with high bleeding risk after PCI, clopidogrel use in CYP2C19 loss-of-function carriers is associated with a significantly increased risk of ischemic events compared to patients with retained inhibitor action.
Supports caution with clopidogrel in CYP2C19 LOF carriers after high-bleeding-risk PCI; extends prior data but remains hypothesis-generating pending RCTs.
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Sawayama et al. (2023) conducted an observational in High bleeding risk after percutaneous coronary intervention (n=618). Clopidogrel in CYP2C19 loss-of-function carriers (decreased P2Y12 inhibitor action) vs. Clopidogrel in CYP2C19 LOF non-carriers or prasugrel (retained P2Y12 inhibitor action) was evaluated on Composite of cardiovascular death, myocardial infarction, or ischemic stroke (aHR 2.78, 95% CI 1.40-5.52, p=0.004). Among patients with high bleeding risk, clopidogrel use in CYP2C19 loss-of-function carriers significantly increased the risk of ischemic events after PCI compared to retained P2Y12 inhibitor action (aHR 2.78).
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