Therapy with clopidogrel based on cyp2c19 genotype
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DOGOT, Marta, POPA, Ana. Therapy with clopidogrel based on cyp2c19 genotype. In: MedEspera: International Medical Congress for Students and Young Doctors, Ed. 7th edition, 3-5 mai 2018, Chişinău. Chisinau, Republic of Moldova: 2018, 7, pp. 99-100.
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MedEspera
7, 2018
Congresul "International Medical Congress for Students and Young Doctors"
7th edition, Chişinău, Moldova, 3-5 mai 2018

Therapy with clopidogrel based on cyp2c19 genotype


Pag. 99-100

Dogot Marta, Popa Ana
 
”Nicolae Testemițanu” State University of Medicine and Pharmacy
 
Disponibil în IBN: 3 noiembrie 2020


Rezumat

Introduction. Combined therapy, clopidogrel plus aspirin, prevents secondary thrombotic in acute coronary syndromes (ACS), after percutaneous coronary interventions (PCI) with placement of a coronary artery stent. Clopidogrel is activated in the liver by cytochrome P450 enzymes. CYP2C19 is the principal enzyme. The most common loss of function variant is CYP2C19*2. This contributes to the decrease in the active metabolite of clopidogrel in the blood and reduce the effectiveness of clopidogrel therapy. Aim of the study. The importance of CYP2C19 genotyping and knowing the patient's phenotype. Materials and methods. Exploring the bibliographic sources in the years 2010 2017 in the databases: PubMed, Google Scholar, Cochrane Results. Numerous meta analyzes have shown that the presence of CYP2C19*2 polymorphism in patients administering clopidogrel, increases the risk of cardiovascular (CV) complications such as: myocardial infarction (MI), ischemic stroke and stent thrombosis. In Marc h 2010, Food and Drug Administration (FDA) recommended genetic testing to determine non functioning CYP2C19 alleles. This test is useful to identify a patient’s CYP2C19 genotype and determines the therapeutic course of action. Individualized antiplatelet t reatment allows us to anticipate potential efficacy, maximize benefits by reducing the risk of recurrent CV events. Studies have shown that genotype guided therapy has economic benefits due to the prevention of adverse cardiac events. American College of C ardiology/American Heart Association (2012) recommended genetic tests for clopidogrel resistance in patients with recurrent CV events despite antiplatelet treatment. The Clinical Pharmacogenetics Implementation Consortium (CPIC) (2013) recommend to use gen otype guided antiplatelet therapy for patients with ACS who are undergoing PCI and use alternative antiplatelet agent (ticagrelor, prasugrel) for intermediate metabolizer (*1/*2; *1/*3; *2/*17) and poor metabilizer (*2/*2; *2/*3; *3/*3), if no contraindica tion. Conclusions. CYP2C19 genotyping is useful to identify intermediate and poor metabolizer, prescribing an antiplatelet therapy based on CYP2C19 genotype that would reduce thrombotic complications. The criteria for personalized therapy have so far not been established that would guarantee the efficacy and individual safety of patients that administer clopidogrel.

Cuvinte-cheie
CYP2C19 genotype, clopidogrel