Impact of CYP2C19 Genetic Testing on Provider Prescribing Patterns for Antiplatelet Therapy After Acute Coronary Syndromes and Percutaneous Coronary Intervention

Citation:

Desai NR, Canestaro WJ, Kyrychenko P, Chaplin D, Martell LA, Brennan T, Matlin OS, Choudhry NK. Impact of CYP2C19 Genetic Testing on Provider Prescribing Patterns for Antiplatelet Therapy After Acute Coronary Syndromes and Percutaneous Coronary Intervention. Circulation. Cardiovascular Quality and Outcomes 2013;6:694-699.
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Date Published:

Nov 5

Abstract:

BACKGROUND: have an increased risk for adverse cardiovascular events. In 2010, the US Food and Drug Administration issued a boxed warning cautioning against the use of clopidogrel in such patients. We sought to assess the impact of CYP2C19 genetic testing on prescribing patterns for antiplatelet therapy among patients with acute coronary syndrome or percutaneous coronary intervention. METHODS AND RESULTS: testing. Genotype and phenotype results were provided to patients and their physicians, but no specific treatment recommendations were suggested. Patients were categorized based on their genotype (carriers versus noncarriers) and phenotype (extensive, intermediate, and poor metabolizers). The primary outcome was intensification in antiplatelet therapy defined as either dose escalation of clopidogrel or replacement of clopidogrel with prasugrel. Between July 2010 and April 2012, 6032 patients were identified, and 499 (8.3%) underwent CYP2C19 genotyping, of whom 146 (30%) were found to have >/=1 reduced function allele, including 15 (3%) with 2 reduced function alleles. Although reduced function allele carriers were significantly more likely than noncarriers to have an intensification of their antiplatelet therapy, only 20% of poor metabolizers of clopidogrel had their antiplatelet therapy intensified. CONCLUSIONS: allele carriers, but only 20% of poor metabolizers of clopidogrel had an escalation in the dose of clopidogrel or were switched to prasugrel. These prescribing patterns likely reflect the unclear impact and evolving evidence for clopidogrel pharmacogenomics.

Last updated on 01/15/2014