What does this research mean for the field?

In patients with coronary heart disease and CYP2C19*2 gene mutations undergoing PCI, alternative antiplatelet strategies such as double-dose clopidogrel, clopidogrel combined with tongxinluo, or ticagrelor improve platelet inhibition and reduce major adverse cardiovascular events compared to standard-dose clopidogrel, though ticagrelor increases hemorrhage risk. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

August 7, 2017Medical Science MonitorOpen Access

Effects of Dual-Dose Clopidogrel, Clopidogrel Combined with Tongxinluo Capsule, and Ticagrelor on Patients with Coronary Heart Disease and CYP2C19*2 Gene Mutation After Percutaneous Coronary Interventions (PCI)

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Why the study?

Does double-dose clopidogrel, clopidogrel combined with tongxinluo, or ticagrelor improve platelet inhibition and reduce MACE compared to standard-dose clopidogrel in patients with coronary heart disease and CYP2C19*2 mutation after PCI?

Structured PICO

Population

212 patients with coronary heart disease and CYP2C19*2 gene mutation (function deficiency and poor clopidogrel response) after percutaneous coronary interventions (PCI)

Intervention

Double-dose clopidogrel (n=50), clopidogrel combined with tongxinluo capsule (n=59), or ticagrelor (n=57)

Comparator

Standard anti-platelet therapy (regular-dose clopidogrel) (n=46)

Outcome

Platelet activity (inhibition of platelet aggregation detected by TEG) and occurrence of MACE eventscomposite

In patients with CYP2C19*2 mutations undergoing PCI, alternative antiplatelet regimens such as ticagrelor, double-dose clopidogrel, or clopidogrel plus tongxinluo improve platelet inhibition and reduce ischemic events compared to standard clopidogrel, though ticagrelor increases bleeding risk.

Implication

May support ticagrelor or alternatives in CYP2C19*2 carriers post-PCI; leaves open randomized confirmation.

Abstract

BACKGROUND In recent years, genetic factors have attracted research interest as important predisposing factors for cardiovascular susceptibility. This study aimed to investigate the influences of dual-dose clopidogrel, clopidogrel combined with tongxinluo, and ticagrelor on the platelet activity and MACE events of patients with CYP2C19*2 gene function deficiency and poor clopidogrel response after PCI. MATERIAL AND METHODS We selected 458 patients with coronary heart disease undergoing PCI, and the genotype of CYP2C19*2 was detected by TaqMan real-time PCR. We finally enrolled 212 patients and divided them into 4 groups: a standard anti-platelet group of 46 patients, a clopidogrel double-dose group of 50 cases, a clopidogrel combined with tongxinluo group of 59 cases, and a ticagrelor group of 57. The platelet inhibition rate was detected by TEG. We analyzed and compared differences in platelet activity and the occurrence of MACE events in these 4 groups at different follow-up times. RESULTS The results showed that inhibition of platelet aggregation was better in the double-dose clopidogrel group, the clopidogrel combined with tongxinluo group, and the ticagrelor group than in the regular-dose clopidogrel group, and ticagrelor was the best. We also found that the total incidence of MACE was much lower in the double-dose clopidogrel group, the clopidogrel combined with tongxinluo group, and the ticagrelor group, while the incidence of hemorrhage in the ticagrelor group was higher. CONCLUSIONS Adjusting the dose or combining with other drugs improves the efficacy of anti-platelet therapy and reduces the incidence of ischemic events after PCI.