CYP2C19 genetic variation and individualized clopidogrel prescription in a cardiology clinic
Background: Clopidogrel (Plavix) is an antiplatelet medication that is routinely used in patients with cardiovascular disease. Cytochrome P2C19 enzymes play a major role in its metabolism, which determines its varied therapeutic level and its effectiveness. Objectives: To customize clopidogrel thera...
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| Format: | Article |
| Language: | English |
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Greater Baltimore Medical Center
2017-07-01
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| Series: | Journal of Community Hospital Internal Medicine Perspectives |
| Subjects: | |
| Online Access: | http://dx.doi.org/10.1080/20009666.2017.1347475 |
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| author | Seyed abbas Mirabbasi Koroush Khalighi Yin Wu Stanley Walker Bahar Khalighi Wuqiang Fan Archana Kodali Gang Cheng |
| author_facet | Seyed abbas Mirabbasi Koroush Khalighi Yin Wu Stanley Walker Bahar Khalighi Wuqiang Fan Archana Kodali Gang Cheng |
| author_sort | Seyed abbas Mirabbasi |
| collection | DOAJ |
| description | Background: Clopidogrel (Plavix) is an antiplatelet medication that is routinely used in patients with cardiovascular disease. Cytochrome P2C19 enzymes play a major role in its metabolism, which determines its varied therapeutic level and its effectiveness. Objectives: To customize clopidogrel therapy and evaluate its efficacy by using CYP2C19 genotypic and phenotypic information to improve clinical outcomes in patients. Methods: A total of 465 patients with underlying cardiovascular disease were selected from our out-patient cardiology clinic. DNA sequences of CYP2C19 were analyzed in 465 patients. Results: Of 465 patients, 183 were wild-type homozygous (*1/*1) and 18.8% gain-of function and 19.8% loss-of-function alleles in our patient population The following changes were made: 1) Switching to prasugrel in patients whose genotype noted them to be “Slow metabolizers. This medication adjustment improved clinical outcomes in this patient group. 2) Discontinuing or lowering clopidogrel doses in patients whose genotypes noted them to be “Fast or ultra-fast metabolizes” to decrease bleeding risk. For those who were not on clopidogrel but carried abnormal allele(s), “clopidogrel caution” was documented. These individuals were followed up for 3 years and there has not been any cardiac clinical symptoms, cardiac death or excessive bleeding reported. Conclusions: Given the varied effectiveness of clopidogrel due to its metabolism by CYP2C19 enzyme, and the relatively high frequency of both gain-of-function (18.8%) and loss-of-function (19.8%) alleles in our patient population, we believe that genotyping CYP2C19 is clinically important in order to improve patient outcomes and minimize patient risk. |
| first_indexed | 2024-04-11T02:30:19Z |
| format | Article |
| id | doaj.art-7d85f6f378774f578c3fcf8b1771e87a |
| institution | Directory Open Access Journal |
| issn | 2000-9666 |
| language | English |
| last_indexed | 2024-04-11T02:30:19Z |
| publishDate | 2017-07-01 |
| publisher | Greater Baltimore Medical Center |
| record_format | Article |
| series | Journal of Community Hospital Internal Medicine Perspectives |
| spelling | doaj.art-7d85f6f378774f578c3fcf8b1771e87a2023-01-02T21:34:04ZengGreater Baltimore Medical CenterJournal of Community Hospital Internal Medicine Perspectives2000-96662017-07-017315115610.1080/20009666.2017.13474751347475CYP2C19 genetic variation and individualized clopidogrel prescription in a cardiology clinicSeyed abbas Mirabbasi0Koroush Khalighi1Yin Wu2Stanley Walker3Bahar Khalighi4Wuqiang Fan5Archana Kodali6Gang Cheng7Easton Hospital, Drexel University College of MedicineEaston Hospital, Drexel University College of MedicineEaston Hospital, Drexel University College of MedicineEaston Hospital, Drexel University College of MedicineTemple UniversityEaston Hospital, Drexel University College of MedicineEaston Hospital, Drexel University College of MedicineCardiovascular InstituteBackground: Clopidogrel (Plavix) is an antiplatelet medication that is routinely used in patients with cardiovascular disease. Cytochrome P2C19 enzymes play a major role in its metabolism, which determines its varied therapeutic level and its effectiveness. Objectives: To customize clopidogrel therapy and evaluate its efficacy by using CYP2C19 genotypic and phenotypic information to improve clinical outcomes in patients. Methods: A total of 465 patients with underlying cardiovascular disease were selected from our out-patient cardiology clinic. DNA sequences of CYP2C19 were analyzed in 465 patients. Results: Of 465 patients, 183 were wild-type homozygous (*1/*1) and 18.8% gain-of function and 19.8% loss-of-function alleles in our patient population The following changes were made: 1) Switching to prasugrel in patients whose genotype noted them to be “Slow metabolizers. This medication adjustment improved clinical outcomes in this patient group. 2) Discontinuing or lowering clopidogrel doses in patients whose genotypes noted them to be “Fast or ultra-fast metabolizes” to decrease bleeding risk. For those who were not on clopidogrel but carried abnormal allele(s), “clopidogrel caution” was documented. These individuals were followed up for 3 years and there has not been any cardiac clinical symptoms, cardiac death or excessive bleeding reported. Conclusions: Given the varied effectiveness of clopidogrel due to its metabolism by CYP2C19 enzyme, and the relatively high frequency of both gain-of-function (18.8%) and loss-of-function (19.8%) alleles in our patient population, we believe that genotyping CYP2C19 is clinically important in order to improve patient outcomes and minimize patient risk.http://dx.doi.org/10.1080/20009666.2017.1347475CYP2C19clopidogrelpharmacogenetic |
| spellingShingle | Seyed abbas Mirabbasi Koroush Khalighi Yin Wu Stanley Walker Bahar Khalighi Wuqiang Fan Archana Kodali Gang Cheng CYP2C19 genetic variation and individualized clopidogrel prescription in a cardiology clinic Journal of Community Hospital Internal Medicine Perspectives CYP2C19 clopidogrel pharmacogenetic |
| title | CYP2C19 genetic variation and individualized clopidogrel prescription in a cardiology clinic |
| title_full | CYP2C19 genetic variation and individualized clopidogrel prescription in a cardiology clinic |
| title_fullStr | CYP2C19 genetic variation and individualized clopidogrel prescription in a cardiology clinic |
| title_full_unstemmed | CYP2C19 genetic variation and individualized clopidogrel prescription in a cardiology clinic |
| title_short | CYP2C19 genetic variation and individualized clopidogrel prescription in a cardiology clinic |
| title_sort | cyp2c19 genetic variation and individualized clopidogrel prescription in a cardiology clinic |
| topic | CYP2C19 clopidogrel pharmacogenetic |
| url | http://dx.doi.org/10.1080/20009666.2017.1347475 |
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