title: Genetic Determinants of P2Y12Inhibitors and Clinical Implications.
abstract: There is significant interpatient variability in clopidogrel effectiveness, which is due in part to cytochrome P450 (CYP) 2C19 genotype. Approximately 30% of individuals carry CYP2C19 loss-of-function alleles, which have been consistently shown to reduce clopidogrel effectiveness after an acute coronary syndrome and percutaneous coronary intervention. Guidelines recommend consideration of prasugrel or ticagrelor in these patients. A clinical trial examining outcomes with CYP2C19 genotype-guided antiplatelet therapy is ongoing. In the meantime, based on the evidence available to date, several institutions have started clinically implementing CYP2C19 genotyping to assist with antiplatelet selection after percutaneous coronary intervention.
authors.affiliation: Department of Pharmacotherapy and Translational Research, Center for Pharmacogenomics, University of Florida, 1333 Center Drive, PO Box 100486, Gainesville, FL 32610, USA. Electronic address: lcavallari@cop.ufl.edu.
authors.forename: Larisa H
authors.initials: LH
authors.lastname: Cavallari
authors.affiliation: Division of General Internal Medicine, Department of Medicine, The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, USA; Department of Pharmacy, The Mount Sinai Hospital, New York, NY, USA.
authors.forename: Aniwaa Owusu
authors.initials: AO
authors.lastname: Obeng
mesh_terms: D054058:Acute Coronary Syndrome / Q000378:metabolism / Q000628:therapy*; D000483:Alleles; D000077144:Clopidogrel; D065731:Cytochrome P-450 CYP2C19 / Q000187:drug effects / Q000235:genetics* / Q000378:metabolism; D005838:Genotype; D006801:Humans; D062645:Percutaneous Coronary Intervention; D020641:Polymorphism, Single Nucleotide; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use; D013927:Thrombosis / Q000235:genetics* / Q000378:metabolism / Q000517:prevention & control; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D058921:Purinergic P2Y Receptor Antagonists; D000077144:Clopidogrel; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19; D013988:Ticlopidine
keywords: CYP2C19; Clopidogrel; Genotype; Pharmacogenomics; Prasugrel; Ticagrelor