1. Impact of Continuous P2Y12 Inhibition Tailoring in Acute Coronary Syndrome and Genetically Impaired Clopidogrel Absorption.
- Author
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Samardzic J, Bozina N, Skoric B, Ganoci L, Krpan M, Petricevic M, Pasalic M, Bozina T, Pavasovic S, Cikes M, and Milicic D
- Subjects
- ATP Binding Cassette Transporter, Subfamily B genetics, ATP Binding Cassette Transporter, Subfamily B metabolism, Acute Coronary Syndrome blood, Acute Coronary Syndrome diagnosis, Aged, Blood Platelets metabolism, Clopidogrel metabolism, Drug Monitoring, Female, Humans, Male, Middle Aged, Platelet Aggregation Inhibitors metabolism, Purinergic P2Y Receptor Antagonists metabolism, Randomized Controlled Trials as Topic, Receptors, Purinergic P2Y12 blood, Treatment Outcome, Acute Coronary Syndrome drug therapy, Blood Platelets drug effects, Clopidogrel administration & dosage, Gastrointestinal Absorption genetics, Pharmacogenomic Variants, Platelet Aggregation drug effects, Platelet Aggregation Inhibitors administration & dosage, Purinergic P2Y Receptor Antagonists administration & dosage, Receptors, Purinergic P2Y12 drug effects
- Abstract
Clopidogrel is still widely used in acute coronary syndrome despite the development of more potent P2Y12 inhibitors. Previously, we conducted a trial that evaluated serial clopidogrel dose adjustment based on platelet function testing in acute coronary syndrome patients with initial high on-treatment platelet reactivity (HTPR). In this substudy, we performed post hoc analysis of the effect of ABCB1 genetic variants C3435T and G2677T/A on platelet inhibition and outcomes. There were no differences in the proportion of HTPR patients among C3435T carriers and noncarriers in both interventional and control group. G2677T carriers expressed significantly higher proportion of HTPR pattern throughout 12-month follow-up in the control group with no difference in the interventional group. There was no difference in ischemic outcomes between C3435T and G2677T carriers and noncarriers in both groups of patients. The results indicate that ABCB1 genotyping is not useful to guide clopidogrel therapy tailoring to improve high-risk patient management.
- Published
- 2020
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