title: Pharmacogenetics of clopidogrel: comparison between a standard and a rapid genetic testing.
abstract: OBJECTIVE
  CYP2C19 variant alleles are independent predictors of clopidogrel response variability and occurrence of major adverse cardiovascular events in high-risk vascular patients on clopidogrel therapy. Increasing evidence suggests a combination of platelet function testing with CYP2C19 genetic testing may be more effective in identifying high-risk individuals for alternative antiplatelet therapeutic strategies. A crucial point in evaluating the use of these polymorphisms in clinical practice, besides test accuracy, is the cost of the genetic test and rapid availability of the results. One hundred acute coronary syndrome patients were genotyped for CYP2C19*2,*3,*4,*5, and *17 polymorphisms with two platforms: Verigene(®) and the TaqMan(®) system.
  
  
  RESULTS
  Genotyping results obtained by the classical TaqMan approach and the rapid Verigene approach showed a 100% concordance for all the five polymorphisms investigated. The Verigene system had shorter turnaround time with respect to TaqMan. The cost of reagents for TaqMan genotyping was lower than that for the Verigene system, but the effective manual staff involvement and the relative cost resulted in higher cost for TaqMan than for Verigene.
  
  
  CONCLUSIONS
  The Verigene system demonstrated good performance in terms of turnaround time and cost for the evaluation of the clopidogrel poor metabolizer status, giving genetic information in suitable time (206 min) for a therapeutic strategy decision.
authors.affiliation: Department of Medical and Surgical Critical Care, University of Florence-Atherothrombotic Diseases Center, AOU Careggi, Florence, Italy. claudiasaracini@hotmail.it
authors.forename: Claudia
authors.initials: C
authors.lastname: Saracini
authors.forename: Anna
authors.initials: A
authors.lastname: Vestrini
authors.forename: Silvia
authors.initials: S
authors.lastname: Galora
authors.forename: Alessandra
authors.initials: A
authors.lastname: Armillis
authors.forename: Rosanna
authors.initials: R
authors.lastname: Abbate
authors.forename: Betti
authors.initials: B
authors.lastname: Giusti
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000235:genetics*; D001189:Aryl Hydrocarbon Hydroxylases / Q000235:genetics*; D000077144:Clopidogrel; D065731:Cytochrome P-450 CYP2C19; D005820:Genetic Testing / Q000191:economics / Q000379:methods*; D005838:Genotype; D006801:Humans; D010597:Pharmacogenetics; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D010979:Platelet Function Tests; D020641:Polymorphism, Single Nucleotide; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D013997:Time Factors
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D001189:Aryl Hydrocarbon Hydroxylases; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19; D013988:Ticlopidine