在患有关键肢体缺血症的患者中对CYP2C19基因型检测的临床观点:德尔菲方法
Christopher Regan1, Lindsey E Scierka1, Alan Dardik2
1Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
Vascular
|April 26, 2024
概括
受克洛皮多格雷尔治疗的外周动脉疾病 (PAD) 患者由于CYP2C19突变而表现出不同的反应. 专家们需要更多的教育和明确的基因测试指南,以优化外周血管干预后的抗血小板治疗.
科学领域:
- 心脏病学和血管外科
- 药物基因组学 药物基因组学
- 临床实践指南 临床实践指南
背景情况:
- 双重抗血小板治疗 (DAPT) 与克洛皮多格勒和阿司匹林是干预后对外周动脉疾病 (PAD) 的标准.
- 由于CYP2C19基因突变,患者对克洛皮多格雷尔的反应有所不同,导致治疗不确定性.
- 关于最佳DAPT持续时间和遗传变异对PAD治疗疗效的影响的数据有限.
研究的目的:
- 评估干预专家对PAD患者CYP2C19突变的知识和态度.
- 确定实施CYP2C19测试和管理策略的障碍.
- 在接受外周血管干预 (PVI) 的PAD患者的CYP2C19测试和管理方面达成共识.
主要方法:
- 使用修改后的Delphi方法,在PAD干预专家之间达成共识.
- 参与者包括耶鲁纽黑文医院的干预心脏病学家,血管外科医生和干预放射学家.
- 三轮调查评估了对CYP2C19测试和管理策略的知识,态度和共识.
主要成果:
- PAD干预专家表示需要对CYP2C19突变进行更多的教育 (中位数8.0).
- 对CYP2C19突变的熟悉程度中等 (中位数为7.0),但感知到的重要性较低 (中位数为6.0).
- 管理层陈述的共识发展,缩小了四分位数间的范围,但没有达到预先规定的协议值.
结论:
- PAD干预专家承认克洛皮多格雷尔的异质反应,但缺乏对利用遗传测试的信心.
- 在PAD管理中的知识,感知障碍和对CYP2C19测试的态度存在重大差距.
- 需要进一步的随机数据来指导基于PVI后PAD患者遗传测试的抗血小板治疗决定.
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