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Should CYP2C19 Genotyping Be Recommended as a Straight Forward Approach to Optimize Clopidogrel Utilization in

Jialin Sun1, Ping Leng1, Chen Sun2

  • 1Department of Pharmacy, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong, People's Republic of China.

Pharmacogenomics and Personalized Medicine
|December 2, 2020
PubMed

Insights

The CYP2C19*2 gene variant is linked to reduced clopidogrel effectiveness and higher risk of high on-treatment platelet reactivity in ischemic stroke patients with type 2 diabetes.

Area of Science:

  • Pharmacogenomics
  • Cardiovascular Medicine
  • Metabolic Disorders

Background:

  • Few studies explore CYP2C19 genotypes and clopidogrel response in ischemic stroke (IS), particularly with type 2 diabetes mellitus (T2DM).
  • Understanding these associations is crucial for optimizing antiplatelet therapy in high-risk populations.

Purpose of the Study:

  • To investigate the association between CYP2C19 polymorphisms and high on-treatment platelet reactivity (HTPR) in Chinese IS patients with T2DM.
  • To identify genetic predictors of clopidogrel response in this specific patient group.

Main Methods:

  • A case-control study involving 426 IS patients with T2DM.
  • Platelet inhibition (PIADP) assessed by thromboelastography (TEG) to define HTPR.
  • CYP2C19 genotypes determined using PCR-RFLP.

Main Results:

  • CYP2C19*2 carriers (heterozygous and homozygous) exhibited significantly lower PIADP compared to non-carriers.
  • The CYP2C19*2 allele was more frequent in the HTPR group.
  • Carriage of the CYP2C19*2 mutant allele significantly increased HTPR risk (OR = 1.94).
  • No significant correlation found for CYP2C19*3 or *17 genotypes with HTPR.

Conclusions:

  • The CYP2C19*2 polymorphism is associated with attenuated platelet response to clopidogrel.
  • CYP2C19*2 may serve as a predictor of HTPR in IS patients with T2DM.
  • This finding highlights the importance of pharmacogenetics in tailoring antiplatelet therapy for T2DM patients with IS.
Abstract

Keywords:
CYP2C19clopidogrelhigh on-treatment platelet reactivityischemic stroketype 2 diabetes mellitus

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