Author + information
- Nihar Desai,
- Will Canestaro,
- Donald Chaplin,
- Lori Martell,
- Olga Matlin,
- Pavlo Kyrychenko,
- Troyen Brennan and
- Niteesh Choudhry
Carriers of CYP2C19 reduced function alleles receiving clopidogrel are at increased risk for major adverse cardiovascular events. However, little is known about how the results of genotype testing influence provider prescribing patterns for antiplatelet therapy.
Patients prescribed clopidogrel were identified via a national claims database and those with a recent ACS or PCI were offered genetic testing. Results were sent to physicians though no specific treatment recommendations were provided. Patients were categorized based on genotype (carriers v. noncarriers) and phenotype (extensive, intermediate, and poor metabolizers). Changes in antiplatelet therapy were captured for 90 days after testing.
Between July 2010 – March 2012, 6,032 patients were identified and 499 (8.3%) underwent genotyping of whom 146 (30%) were found to have at least 1 reduced function allele, including 15 (3%) with 2 reduced function alleles. Although reduced function allele carriers were significantly more likely than non-carriers to be switched to prasugrel (18% v. 2%), only 20% of poor metabolizers had an escalation in their antiplatelet therapy (Figure).
Providers were significantly more likely to alter the antiplatelet regimen in carriers of reduced function CYP2C19 alleles, but only 20% of those at highest risk were switched to prasugrel. These prescribing patterns likely reflect the unclear impact and rapidly evolving evidence for clopidogrel pharmacogenomics.
Moderated Poster Contributions
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: ACS Therapy
Abstract Category: 3. Acute Coronary Syndromes: Therapy
Presentation Number: 1255M-177
- 2013 American College of Cardiology Foundation