Genotype- and phenotype-directed personalization of antiplatelet treatment in patients with non-ST elevation acute coronary syndromes undergoing coronary stenting
Sung Gyun Ahn,Junghan Yoon,Juwon Kim,Young Uh,Kyung Min Kim,Ji Hyun Lee,Jun Won Lee,Young Jin Youn,Min Soo Ahn,Jang Young Kim,Byung Su Yoo,Seung Hwan Lee,Seung-Jea Tahk,Kyung Hoon Choe +13 more
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TLDR
Tailored antiplatelet therapy according to point-of-care genetic and phenotypic testing may be effective in decreasing HOPR after 30 days of treatment.Abstract:
Background and Objectives: We evaluated the effectiveness of genotype- and phenotype-directed individualization of P2Y12 inhibitors to decrease high on-treatment platelet reactivity (HOPR). Subjects and Methods: Sixty-five patients undergoing percutaneous coronary intervention for non-ST elevation acute coronary syndromes were randomly assigned to genotype- or phenotype-directed treatment. All patients were screened for CYP2C19*2, *3, or *17 alleles by using the Verigene CLO assay (Nanosphere, Northbrook, IL, USA). The P2Y12 reaction unit (PRU) was measured using the VerifyNow P2Y12 assay (Accumetrics, San Diego, CA, USA). 21 CYP2C19 *2 or *3 carriers (65.6%) and 11 patients with HOPR (33.3%), defined as a PRU value ≥230, were given 90 mg ticagrelor twice daily; non-carriers and patients without HOPR were given 75 mg clopidogrel daily. The primary endpoint was the percentage of patients with HOPR after 30 days of treatment. Results: PRU decreased following both genotype- and phenotype-directed therapies (242±83 vs. 109±90, p<0.001 in the genotype-directed group; 216±74 vs. 109±90, p=0.001 in the phenotype-directed group). Five subjects (16.2%) in the genotype-directed group and one (3.3%) in the phenotype-directed group had HOPR at day 30 (p=0.086). All patients with HOPR at the baseline who received ticagrelor had a PRU value of <230 after 30 days of treatment. Conversely, clopidogrel did not lower the number of patients with HOPR at the baseline. Conclusion: Tailored antiplatelet therapy according to point-of-care genetic and phenotypic testing may be effective in decreasing HOPR after 30 days. (Korean Circ J 2013;43:541-549)read more
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Triple versus dual antiplatelet therapy in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention
Kang Yin Chen,Seung-Woon Rha,Yong Jian Li,Kanhaiya L. Poddar,Zhe Jin,Yoshiyasu Minami,Lin Wang,Eung Ju Kim,Chang Gyu Park,Hong Seog Seo,Dong Joo Oh,Myung Ho Jeong,Young Keun Ahn,Taek Jong Hong,Young Jo Kim,Seung Ho Hur,In Whan Seong,Jei Keon Chae,Myeong Chan Cho,Jang Ho Bae,Donghoon Choi,Yangsoo Jang,In Ho Chae,Chong Jin Kim,Jung Han Yoon,Wook Sung Chung,Ki Bae Seung,Seung-Jung Park +27 more
TL;DR: In this paper, a total of 4203 acute ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention with drug-eluting stents were analyzed retrospectively in the Korean Acute Myocardial Infarction Registry (KAMIR).
Journal ArticleDOI
The Personalization of Clopidogrel Antiplatelet Therapy: The Role of Integrative Pharmacogenetics and Pharmacometabolomics.
Arwa M. Amin,Lim Sheau Chin,Dzul Azri Mohamed Noor,Muhamad Ali Sk Abdul Kader,Yuen Kah Hay,Baharudin Ibrahim +5 more
TL;DR: This review aimed to review the literature on factors associated with the variable platelets reactivity response to clopidogrel, as well as appraising current methods for the personalization of clopIDogrel therapy.
Journal ArticleDOI
2018 update of expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI
Yong Huo,Young-Hoon Jeong,Gong Yanjun,Daowen Wang,Ben He,Jiyan Chen,Guosheng Fu,Yundai Chen,Jianping Li,Yi Li,Shinya Goto,Udaya S. Tantry,Paul A. Gurbel,Jong Hwa Ahn,Hyo-Soo Kim,Myung Ho Jeong,Yaling Han,Sidney C. Smith,Junbo Ge +18 more
TL;DR: This updated consensus mainly focuses on state-of-the-art and current controversies in the East Asian population and when East Asian patients are administered potent P2Y12 receptor inhibitors, the strategies and ongoing trials to overcome the related hurdles are discussed.
Journal ArticleDOI
The pharmacogenetic control of antiplatelet response: candidate genes and CYP2C19.
TL;DR: An overview of the available antiplatelet pharmacogenetics literature is provided and abundant data support the clinical validity of CYP2C19 and clopidogrel response variability among ACS/PCI patients.
Journal ArticleDOI
Ticagrelor Versus Clopidogrel in Black Patients With Stable Coronary Artery Disease Prospective, Randomized, Open-Label, Multiple-Dose, Crossover Pilot Study
Ron Waksman,Juan Maya,Dominick J. Angiolillo,Glenn F. Carlson,Renli Teng,Richard J. Caplan,Keith C. Ferdinand +6 more
TL;DR: In black patients with stable CAD receiving low-dose acetylsalicylic acid, ticagrelor provided a faster onset and greater degree of platelet inhibition than clopidogrel.
References
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Prasugrel versus Clopidogrel in Patients with Acute Coronary Syndromes
Stephen D. Wiviott,Eugene Braunwald,Carolyn H. McCabe,Gilles Montalescot,Witold Rużyłło,Shmuel Gottlieb,Franz Joseph Neumann,Diego Ardissino,Stefano De Servi,Sabina A. Murphy,Jeffrey S. Riesmeyer,Govinda Weerakkody,C. Michael Gibson,Elliott M. Antman +13 more
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TL;DR: The antiplatelet agent clopidogrel has beneficial effects in patients with acute coronary syndromes without ST-segment elevation, however, the risk of major bleeding is increased among patients treated with clopIDogrel.
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Ticagrelor versus Clopidogrel in Patients with Acute Coronary Syndromes
Lars Wallentin,Richard C. Becker,Andrzej Budaj,Christopher P. Cannon,Håkan Emanuelsson,Claes Held,Jay Horrow,Steen Husted,Stefan James,Hugo A. Katus,Kenneth W. Mahaffey,Benjamin M. Scirica,Allan M. Skene,Philippe Gabriel Steg,Robert F. Storey,Robert A. Harrington +15 more
TL;DR: In patients who have an acute coronary syndrome with or without ST-segment elevation, treatment with ticagrelor as compared with clopidogrel significantly reduced the rate of death from vascular causes, myocardial infarction, or stroke without an increase in the rates of overall major bleeding but with an increase of non-procedure-related bleeding.
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TL;DR: Bleeding complications have been associated with an increased risk of subsequent adverse outcomes, including MI, stroke, stent thrombosis, and death, in patients with ACS and in those undergoing percutaneous coronary intervention (PCI) as well as in the long-term antithrombotic setting.
Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without st-segment elevation
TL;DR: The antiplatelet agent clopidogrel has beneficial effects in patients with acute coronary syndromes without ST-segment elevation, however, the risk of major bleeding is increased among patients treated with clopIDogrel.
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