Klein Melissa D, Lee Craig R, Stouffer George A
Division of Cardiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
McAllister Heart Institute, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Pharmacogenomics. 2018 Aug 1;19(13):1039-1046. doi: 10.2217/pgs-2018-0072. Epub 2018 Jul 20.
It is well established that the CYP2C19 nonfunctional *2 and *3 polymorphisms impair the bioactivation and antiplatelet effects of clopidogrel, and increase the risk of adverse cardiovascular events following percutaneous coronary intervention. In contrast, CYP2C19 genotype does not impact clinical response to prasugrel or ticagrelor. Recent studies have evaluated the impact of CYP2C19 genotype-guided selection of antiplatelet therapy on clinical outcomes and begun to close some of the gaps in knowledge and uncertainty that have impeded widespread clinical implementation of this precision medicine approach. This review will critically evaluate recent data and offer new insight into the potential clinical utility of genotype-guided antiplatelet therapy in the context of current clinical practice guidelines.
众所周知，细胞色素P450 2C19（CYP2C19）的无功能2和3多态性会损害氯吡格雷的生物活化和抗血小板作用，并增加经皮冠状动脉介入治疗后发生不良心血管事件的风险。相比之下，CYP2C19基因型不会影响普拉格雷或替格瑞洛的临床反应。最近的研究评估了CYP2C19基因型指导的抗血小板治疗选择对临床结局的影响，并开始填补一些阻碍这种精准医学方法广泛临床应用的知识空白和不确定性。本综述将批判性地评估近期数据，并在当前临床实践指南的背景下，对基因型指导的抗血小板治疗的潜在临床应用提供新的见解。
