CYP2C19 genotype-guided antiplatelet therapy: promises and pitfalls.
Moataz EllithiJordan BayeRussell A WilkePublished in: Pharmacogenomics (2020)
Pharmacogenetic variants can alter the mechanism of action (pharmacodynamic gene variants) or kinetic processes such as absorption, distribution, metabolism and elimination (pharmacokinetic gene variants). Many initial successes in precision medicine occurred in the context of genes encoding the cytochromes P450 (CYP enzymes). CYP2C19 activates the antiplatelet drug clopidogrel, and polymorphisms in the CYP2C19 gene are known to alter the outcome for patients taking clopidogrel in the context of cardiovascular disease. CYP2C19 loss-of-function alleles are specifically associated with increased risk for coronary stent thrombosis and major adverse cardiovascular events in patients taking clopidogrel following percutaneous coronary intervention. We explore successes and challenges encountered as the clinical and scientific communities advance CYP2C19 genotyping in the context of routine patient care.
Keyphrases
- percutaneous coronary intervention
- antiplatelet therapy
- acute coronary syndrome
- coronary artery disease
- copy number
- cardiovascular events
- cardiovascular disease
- genome wide
- end stage renal disease
- st segment elevation myocardial infarction
- acute myocardial infarction
- st elevation myocardial infarction
- ejection fraction
- newly diagnosed
- prognostic factors
- type diabetes
- genome wide identification
- heart failure
- dna methylation
- emergency department
- pulmonary embolism
- atrial fibrillation
- high throughput
- metabolic syndrome
- electronic health record
- clinical practice
- genome wide analysis
- adverse drug