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克洛皮多格勒与替代P2Y抑制剂的有效性12 基于ABCD-GENE评分
Cameron D Thomas1, Francesco Franchi2, Joseph S Rossi3
1Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics and Precision Medicine, College of Pharmacy, University of Florida, Gainesville, Florida, USA.
Journal of the American College of Cardiology
|April 10, 2024
概括
在皮肤冠状动脉干预 (PCI) 后,对于患有CYP2C19功能丧失等位基因的患者,建议使用替代P2Y12抑制剂治疗,而不是使用克洛皮多格勒. 克洛皮多格勒与非LOF患者的替代疗法同样有效,其ABCD-GENE得分较低.
科学领域:
- 心脏病学 心脏病学
- 药物基因组学 药物基因组学
- 干预心脏病学 干预心脏病学
背景情况:
- ABCD-GENE评分 (年龄,BMI,CKD,糖尿病,CYP2C19变体) 预测了克洛皮多格雷尔的反应,但其对替代P2Y12抑制剂的影响尚不清楚.
- 皮肤冠状动脉干预 (PCI) 患者需要有效的抗血小板治疗.
研究的目的:
- 评估ABCD-GENE评分与克洛皮多格勒与PCI后其他P2Y12抑制剂 (普拉苏格勒,提卡格勒) 的有效性之间的关联.
- 根据ABCD-GENE得分和CYP2C19基因型来确定最佳的P2Y12抑制剂选择.
主要方法:
- 对接受PCI,CYP2C19基因定型和P2Y12抑制剂治疗的4335名患者的分析.
- 主要结局:1年内发生主要动脉血栓事件 (MAE).
- 考克斯回归与反向概率加权,按ABCD-GENE得分和CYP2C19功能丧失 (LOF) 状态分层.
主要成果:
- 对于ABCD-GENE评分<10或≥10.0的患者,替代疗法和克洛皮多格雷尔之间的MAE没有显著差异.
- 在CYP2C19 LOF载体中,替代疗法显示出较低MAE (得分<10) 和显著较低MAE (得分≥10) 的趋势.
- 在非LOF患者的治疗之间,MAE没有差异,得分<10.
结论:
- 在PCI后的CYP2C19 LOF载体中,替代P2Y12抑制剂比克洛皮多格勒更受青,无论ABCD-GENE得分如何.
- 克洛皮多格雷尔在非LOF患者的ABCD-GENE得分<10.0的患者中显示出与替代疗法相比的有效性.
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