Departments of Cardiovascular Diseases.
Laboratory Diagnostics; and.
J Cardiovasc Pharmacol. 2020 Feb;75(2):174-179. doi: 10.1097/FJC.0000000000000767.
Clopidogrel is still widely used in acute coronary syndrome despite the development of more potent P2Y12 inhibitors. Previously, we conducted a trial that evaluated serial clopidogrel dose adjustment based on platelet function testing in acute coronary syndrome patients with initial high on-treatment platelet reactivity (HTPR). In this substudy, we performed post hoc analysis of the effect of ABCB1 genetic variants C3435T and G2677T/A on platelet inhibition and outcomes. There were no differences in the proportion of HTPR patients among C3435T carriers and noncarriers in both interventional and control group. G2677T carriers expressed significantly higher proportion of HTPR pattern throughout 12-month follow-up in the control group with no difference in the interventional group. There was no difference in ischemic outcomes between C3435T and G2677T carriers and noncarriers in both groups of patients. The results indicate that ABCB1 genotyping is not useful to guide clopidogrel therapy tailoring to improve high-risk patient management.
尽管出现了更有效的 P2Y12 抑制剂，氯吡格雷在急性冠脉综合征中仍被广泛应用。此前，我们进行了一项临床试验，评估了基于血小板功能试验对初始高反应性血小板治疗的急性冠脉综合征患者进行氯吡格雷剂量调整。在本亚研究中，我们对 ABCB1 基因变异 C3435T 和 G2677T/A 对血小板抑制和结果的影响进行了事后分析。在干预组和对照组中，C3435T 携带者和非携带者的 HTPR 患者比例没有差异。在对照组中，G2677T 携带者在整个 12 个月的随访中表现出更高比例的 HTPR 模式，而在干预组中则没有差异。在两组患者中，C3435T 和 G2677T 携带者和非携带者的缺血性结局没有差异。结果表明，ABCB1 基因分型对指导氯吡格雷治疗的个体化以改善高危患者管理没有帮助。
