More Controversy over Clopidogrel

A meta-analysis supports the association of even one CYP2C19 risk allele with adverse outcomes of acute coronary syndromes in clopidogrel-treated patients.

Clopidogrel prevents stent thrombosis and cardiovascular events in patients with acute coronary syndromes (ACS) by inhibiting the adenosine diphosphate P2Y₁₂ platelet receptor. Variability in patients' pharmacodynamic response to clopidogrel has generated controversy over dosing, the concomitant use of proton pump inhibitors (JW Cardiol Oct 6 2010), and the need for functional or genetic testing.

In this collaborative meta-analysis, data were pooled from nine genetic studies including 9685 ACS patients; median study follow-ups ranged from 30 days to about 1 year. One reduced-function CYP2C19 allele was identified in 26%, and two reduced-function alleles in 2%, of patients. Incidence of the composite of death, myocardial infarction, and ische…

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI