Impact of the CYP2C19 Gene Polymorphism on Clopidogrel Personalized Drug Regimen and the Clinical Outcomes.
BACKGROUND
Although the relationship between CYP2C19 genotype and clopidogrel metabolism has been studied clearly, we have not seen the report that clopidogrel was administered at a dose adjusted based on genotyping. The two main polymorphism loci of CYP2C19 gene were detected by the CYP2C19 genetic testing. ADP platelet aggregation technology was used to investigate the correlation between clinical effect and the clopidogrel dose, genetic metabolic type, physiological, pathological and other factors, to provide new ideas for clopidogrel therapy for percutaneous coronary intervention postoperation patients.


METHODS
A total of 48 patients were enrolled. All patients were given clopidogrel routine maintenance dose treatment and underwent CYP2C19 genotyping and platelet function testing. Patients were divided into extensive metabolizers, intermediate metabolizers, and poor metabolizers based on the different CYP2C19 genotypes. The clopidogrel dosage was adjusted to double the maintenance dose for the ineffective patients.


RESULTS
The study showed that all patients had no toxic side effects. The low responsiveness to clopidogrel in patients with diabetes is closely related to insulin resistance. Patients with hypertension and hyperlipidemia may increase the risk of clopidogrel resistance. The occurrence of clopidogrel resistance is associated with the CYP2C19 polymorphism in the < 65-year-old female patients.


CONCLUSIONS
For percutaneous coronary intervention in postoperative patients, research data is still lacking regarding clopidogrel dosage on the basis of different CYP2C19 genotypes. Looking forward, more rigorous research programs need to be designed to bring more guidance for clinical application.
Keguang
K
Chen
Rui
R
Zhang
Huanjun
H
Liu
Xi
X
Guo
Pingli
P
Li
Xuehong
X
Liu
D000368:Aged; D000077144:Clopidogrel; D065731:Cytochrome P-450 CYP2C19 / Q000235:genetics*; D004351:Drug Resistance / Q000235:genetics; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention; D010974:Platelet Aggregation; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects / Q000378:metabolism*; D011110:Polymorphism, Genetic; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000378:metabolism
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19; D013988:Ticlopidine