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
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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