Document Detail


The case for routine genotyping in dual-antiplatelet therapy.
MedLine Citation:
PMID:  20471193     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Over 1 million coronary stent procedures are performed annually in the U.S., with dual-antiplatelet therapy, which includes the use of both aspirin and clopidogrel, being a cornerstone in the management of these patients after coronary intervention. Now, recent data have surfaced demonstrating altered active metabolite levels of clopidogrel in patients harboring hepatic cytochrome gene variants. These variants, which have been validated through genome-wide association as the dominant explanation for the marked heterogeneity of clopidogrel response, are linked to a significant increase in the risk for bleeding, stent thrombosis, myocardial infarction, and death. With viable alternatives to clopidogrel now available, including higher clopidogrel maintenance and loading doses, prasugrel, and ticagrelor, clinicians can now effectively guide therapy in those with at-risk gene variants by simple genotyping. Such an individualized approach can potentially prevent tens of thousands of adverse cardiovascular events in the over 30% of those with European ancestry and over 40% of those with Asian or African ancestry who harbor these important clopidogrel gain-of-function and loss-of-function alleles.
Authors:
Samir B Damani; Eric J Topol
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Publication Detail:
Type:  Journal Article     Date:  2010-05-13
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  56     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-12     Completed Date:  2010-07-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  109-11     Citation Subset:  AIM; IM    
Copyright Information:
Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Affiliation:
Division of Cardiovascular Diseases, Scripps Clinic, La Jolla, California 92037, USA.
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MeSH Terms
Descriptor/Qualifier:
Coronary Disease / therapy
Cytochrome P-450 Enzyme System / genetics*
Genotype
Humans
Platelet Aggregation Inhibitors / administration & dosage*
Ticlopidine / administration & dosage,  analogs & derivatives*
Chemical
Reg. No./Substance:
0/Platelet Aggregation Inhibitors; 55142-85-3/Ticlopidine; 90055-48-4/clopidogrel; 9035-51-2/Cytochrome P-450 Enzyme System
Comments/Corrections
Comment In:
J Am Coll Cardiol. 2010 Jul 6;56(2):112-6   [PMID:  20471192 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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