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January 1, 2013Circulation JournalOpen Access

Relationship Between CYP2C19 Loss-of-Function Polymorphism and Platelet Reactivities With Clopidogrel Treatment in Japanese Patients Undergoing Coronary Stent Implantation

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Why the study?

Does CYP2C19 loss-of-function genotype increase platelet reactivity in Japanese patients receiving clopidogrel after coronary stenting?

Population

155 Japanese patients in a steady state receiving dual antiplatelet therapy after coronary stent implantation

Comparison

CYP2C19 loss-of-function genotype carrier status vs Extensive metabolizers

Design

Cross-sectional

Authors

TNTomoyuki NakataNaga Municipal HospitalMMMasatoshi MiyaharaMie UniversityKNKaname NakataniMie University

Discussion

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Implication

May guide clopidogrel selection in Japanese post-stent patients; extends pharmacogenetic data but leaves outcome impact open.

Structured PICO

Does CYP2C19 loss-of-function genotype increase platelet reactivity in Japanese patients receiving clopidogrel after coronary stenting?

P
Population
155 Japanese patients in a steady state receiving dual antiplatelet therapy (including clopidogrel) after coronary stent implantation
I
Intervention
CYP2C19 loss-of-function genotype (*2 and/or *3 alleles) carrier status (intermediate or poor metabolizers)
C
Comparator
Extensive metabolizers (no loss-of-function alleles)
O
Outcome
Platelet reactivity assessed by ADP-specific assays (ADP-LTA, VASP index, VerifyNow-P2Y12) and other markers (soluble P-selectin, platelet-derived microparticles, shear stress-induced platelet aggregometry)surrogate

CYP2C19 loss-of-function alleles significantly increase on-treatment platelet reactivity in Japanese patients on clopidogrel after coronary stenting, demonstrating a gene-dose effect.

Cite This Study

Nakata et al. (2013) studied this question.

synapsesocial.com/papers/6a767ee53a7d5cabaf2959b3https://doi.org/10.1253/circj.cj-12-1095

Topics

Dual antiplatelet therapy
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1CYP2C19 and Nongenetic Factors Predict Poor Responsiveness to Clopidogrel Loading dose after Coronary Stent Implantation2008 · 214 citations
  2. 2Pretreatment with different loading doses of clopidogrel influences P-selectin levels in patients undergoing percutaneous coronary intervention: results from the ARMYDA-2 (antiplatelet therapy for reduction of myocardial damage during angioplasty) SELECT substudy2010 · 2 citations
  3. 3ADP-induced platelet aggregation and platelet reactivity index VASP are good predictive markers for clinical outcomes in non-ST elevation acute coronary syndrome2007 · 203 citations
  4. 4Platelet-derived microparticle levels are significantly elevated in patients treated by elective stenting compared to subjects with diagnostic catheterization alone2010 · 20 citations
  5. 5Impact of Platelet Reactivity to Adenosine Diphosphate Before Implantation of Drug-Eluting Stents on Subsequent Adverse Cardiac Events in Patients With Stable Angina2012 · 9 citations