Genotyping-guided approach versus the conventional approach in selection of oral P2Y12 receptor blockers in Chinese patients suffering from acute coronary syndrome
Autor: | Shun Ling Kong, Stephen M. S. Lee, Raymond C.K. Chan, David C.W. Siu, Catherine P. Shea, Janette Kwok, Wing Hong Tang, Arthur Yung, Anthony Wong, Chor Cheung Tam |
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Rok vydání: | 2016 |
Předmět: |
Male
Ticagrelor Adenosine Genotyping Techniques Platelet Aggregation Gene Expression 030204 cardiovascular system & hematology Biochemistry 0302 clinical medicine Gene Frequency Medicine Prospective Studies 030212 general & internal medicine Prospective cohort study education.field_of_study General Medicine Middle Aged Receptors Purinergic P2Y12 Clopidogrel Cardiology Platelet aggregation inhibitor Female Blood Platelets medicine.medical_specialty Acute coronary syndrome Ticlopidine Genotype Population CYP2C19 acute coronary syndrome 03 medical and health sciences Asian People Internal medicine Humans education Genotyping Allele frequency Alleles Aged business.industry Biochemistry (medical) Thrombosis Research Reports Cell Biology medicine.disease Cytochrome P-450 CYP2C19 Mutation Purinergic P2Y Receptor Antagonists P2Y12 receptor business Platelet Aggregation Inhibitors |
Zdroj: | The Journal of International Medical Research |
ISSN: | 1473-2300 0300-0605 |
Popis: | Objective The CYP2C19 loss-of-function (LoF) allele is present in half of the East Asian population and is associated with high on-treatment platelet reactivity (HTPR). This study aimed to investigate whether a rapid genotyping-guided approach is feasible and efficacious for selecting P2Y12 receptor blockers in Chinese patients suffering from acute coronary syndrome (ACS). Methods This was a single-centre, prospective, randomized, open-label study. A total of 132 patients with ACS were randomized to the rapid genotyping-guided treatment group (GG, N = 65) or the standard treatment group (SG, N = 67). Patients in the GG group were genotyped by the Verigene system. Patients with the CYP2C19 LoF allele were switched to ticagrelor and all remaining patients continued on clopidogrel. The endpoints were HTPR at 24 hours after the first loading dose of clopidogrel and 1 month afterwards. Results Forty patients in the GG group switched to ticagrelor, while others continued on clopidogrel. The incidence of HTPR in the GG vs SG groups was 9.2% vs 40.3% at 24 hours and 6.5% vs 32.3% at 1 month, respectively. Rapid point-of-care genotyping showed 100% concordance with conventional genotyping by real-time polymerase chain reaction. Conclusions In Chinese patients suffering from ACS, the rapid genotyping-guided approach for selecting P2Y12 receptor blockers is feasible and reduces the incidence of HTPR. Clinical Trial Registration URL: http://clinicaltrials.gov . Unique identifier: NCT01994941. |
Databáze: | OpenAIRE |
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