Azzahhafi Jaouad, Broek Wout W A van den, Chan Pin Yin Dean R P P, Harmsze Ankie M, van Schaik Ron H N, Ten Berg Jurriën M
Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands.
Department of Clinical Pharmacy, St. Antonius Hospital, Nieuwegein, the Netherlands.
J Cardiovasc Pharmacol Ther. 2023 Jan-Dec;28:10742484231210704. doi: 10.1177/10742484231210704.
Guidelines recommend prasugrel or ticagrelor for acute coronary syndrome (ACS) patients. However, these P2Y inhibitors increase bleeding risk compared to clopidogrel. Although genotype-guided P2Y-inhibitor selection has been shown to reduce bleeding risk, data on its clinical implementation is lacking.
The study included ACS patients receiving genotype-guided antiplatelet therapy, utilising either a point-of-care (POC) device or laboratory-based testing. We aimed to collect qualitative and quantitative data on genotyping, eligibility for de-escalation, physician adherence to genotype results, time to de-escalation and cost reduction.
Of the 1,530 patients included in the ACS registry from 2021 to 2023, 738 ACS patients treated with ticagrelor received a genotype test. The median turnover time of genotyping was 6.3 hours (interquartile range [IQR], 3.2-16.7), with 82.3% of the genotyping results known within 24 hours after admission. POC genotyping exhibited significantly shorter turnaround times compared to laboratory-based testing (with respective medians of 5.7 vs 47.8 hours; < .001). Of the genotyped patients, 81.7% were eligible for de-escalation which was carried out within 24 hours in 70.9% and within 48 h in 93.0%. The time to de-escalation was significantly shorter using POC (25.4 hours) compared to laboratory-based testing (58.9 hours; < .001). Implementing this strategy led to a reduction of €211,150.50 in medication costs.
CYP2C19 genotype-guided-de-escalation in an all-comers ACS population is feasible. POC genotyping leads to shorter turnaround times and quicker de-escalation. Time to de-escalation from ticagrelor to clopidogrel in noncarriers was short, with high physician adherence to genotype results.
指南推荐普拉格雷或替格瑞洛用于急性冠状动脉综合征（ACS）患者。然而，与氯吡格雷相比，这些P2Y抑制剂会增加出血风险。尽管基因分型指导的P2Y抑制剂选择已被证明可降低出血风险，但缺乏其临床应用的数据。
该研究纳入了接受基因分型指导抗血小板治疗的ACS患者，采用即时检验（POC）设备或基于实验室的检测方法。我们旨在收集关于基因分型、降阶梯治疗资格、医生对基因分型结果的依从性、降阶梯治疗时间和成本降低的定性和定量数据。
在2021年至2023年纳入ACS登记册的1530例患者中，738例接受替格瑞洛治疗的ACS患者进行了基因分型检测。基因分型的中位周转时间为6.3小时（四分位间距[IQR]，3.2 - 16.7），82.3%的基因分型结果在入院后24小时内已知。与基于实验室的检测相比，POC基因分型的周转时间明显更短（中位数分别为5.7小时和47.8小时；<0.001）。在进行基因分型的患者中，81.7%有资格进行降阶梯治疗，其中70.9%在24小时内进行了降阶梯治疗，93.0%在48小时内进行了降阶梯治疗。与基于实验室的检测相比，使用POC进行降阶梯治疗的时间明显更短（25.4小时）（58.9小时；<0.001）。实施该策略使药物成本降低了211,150.50欧元。
在所有ACS患者群体中，CYP2C19基因分型指导的降阶梯治疗是可行的。POC基因分型可缩短周转时间并加快降阶梯治疗。非携带者从替格瑞洛降阶梯至氯吡格雷的时间较短，医生对基因分型结果的依从性较高。
