Antiplatelet therapy guided by CYP2C19 point-of-care pharmacogenetics plus multidimensional treatment decisions.
Victor VoicuNicolas DiehmIgal MoarofSarah ParejoFlorent BadiquéAndrea BurdenDavid NiedrigMarkus BéchirStefan RussmannPublished in: Pharmacogenomics (2024)
Aim: Implementation of CYP2C19 point-of-care (POC) pharmacogenetic (PGx) testing with personalized treatment recommendations. Methods: POC CYP2C19 genotyping plus expert evaluation of risk factors for ischemic and bleeding events. Results: 167 patients underwent PGx testing, 54 (32.3%) were CYP2C19 loss of function carriers, and POC versus standard PGx analysis results for *2 and *3 variants matched in 100%. Antiplatelet therapy was adjusted in 44 patients (26.3%), but always required consideration of patient-specific factors. Conclusion: CYP2C19 POC-PGx is reliable and offers clinically relevant advantages for immediate evidence-based adaptations of antiplatelet therapy, whereas in less acute cases conventional PGx testing can also have advantages. Antiplatelet therapy has become more complex, and implementation of PGx-based personalized antiplatelet therapy requires complementary expert knowledge.
Keyphrases
- antiplatelet therapy
- acute coronary syndrome
- percutaneous coronary intervention
- end stage renal disease
- healthcare
- newly diagnosed
- ejection fraction
- chronic kidney disease
- primary care
- coronary artery disease
- peritoneal dialysis
- clinical practice
- atrial fibrillation
- intensive care unit
- gene expression
- liver failure
- patient reported outcomes
- hepatitis b virus
- genome wide
- subarachnoid hemorrhage
- psychometric properties