Genotype-Phenotype Association and Impact on Outcomes following Guided De-Escalation of Anti-Platelet Treatment in Acute Coronary Syndrome Patients: The TROPICAL-ACS Genotyping Substudy
| Autor: | Steffen Massberg, Lisa Gross, Dietmar Trenk, Fabian Stimpfle, Anne Krieg, Martin Hadamitzky, Dirk Sibbing, Anja Vogelgesang, Monika Baylacher, Julia Hromek, Meinrad Gawaz, Tobias Geisler, Daniel Aradi, Claudius Jacobshagen |
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| Rok vydání: | 2018 |
| Předmět: |
Blood Platelets
Male medicine.medical_specialty Acute coronary syndrome Prasugrel Genotype medicine.medical_treatment Population CYP2C19 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Percutaneous Coronary Intervention Internal medicine medicine Humans 030212 general & internal medicine Acute Coronary Syndrome education Alleles Cells Cultured Genetic Association Studies Aged education.field_of_study Polymorphism Genetic business.industry Drug Substitution Patient Selection Percutaneous coronary intervention Hematology Middle Aged medicine.disease Clopidogrel Platelet Activation 3. Good health Clinical trial Cytochrome P-450 CYP2C19 Treatment Outcome Conventional PCI Purinergic P2Y Receptor Antagonists Female business Prasugrel Hydrochloride Platelet Aggregation Inhibitors medicine.drug |
| Zdroj: | Thrombosis and haemostasis. 118(9) |
| ISSN: | 2567-689X |
| Popis: | Background Phenotype-guided de-escalation (PGDE) of P2Y12-inhibitor treatment with an early switch from prasugrel to clopidogrel was identified as an effective alternative treatment strategy in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). The Testing Responsiveness to Platelet Inhibition on Chronic Antiplatelet Treatment for Acute Coronary Syndromes (TROPICAL-ACS) Genotyping Substudy aimed to investigate whether CYP2C19 genotypes correlate with on-treatment platelet reactivity (PR) in ACS patients treated with clopidogrel or prasugrel and thus might be useful for guidance of early de-escalation of anti-platelet treatment. Methods and Results A total of 603 ACS consecutive patients were enrolled in four centres (23.1% of the overall TROPICAL-ACS population). Rapid genotyping (Spartan RX) for CYP2C19*2, *3 and *17 alleles was performed. Associations between PR and the primary and secondary endpoints of the TROPICAL-ACS trial and CYP2C19*2 and CYP2C19*17 carrier status were evaluated.For the PGDE group, the on-clopidogrel PR significantly differed across CYP2C19*2 (p Conclusion CYP2C19*2 and CYP2C19*17 carrier status correlates with PR in ACS patients treated with clopidogrel and thus might be useful for pre-selecting patients who will and who may not be suitable for PGDE of anti-platelet treatment. Regarding phenotype-guided treatment, we did not observe added benefit of genotyping to predict ischaemic and bleeding risk in patients who underwent a PGDE approach. Clinical Trial Registration URL: https//www.clinicaltrials.gov. Unique Identifier: NCT: 01959451. |
| Databáze: | OpenAIRE |
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