Editor’s Choice Academic Journal Main Category: Cardiovascular / Cardiology Also Included In: Heart Disease;Genetics Article Date: 30 Mar 2012 – 8:00 PDT

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Following PCI, the standard care for patients commonly consists of aspirin and clopidogrel to reduce the risk of blood clot formation, however, this dual antiplatelet therapy results in many patients becoming vulnerable to major adverse cardiovascular events.

This persistent vulnerability is linked to elevated on-treatment platelet reactivity, which can lead to a sudden blockage in the stents that can cause heart attacks or death. The characteristics of elevated on-treatment platelet reactivity are inadequate inhibition of the platelet PsY12 receptor following clopidogrel treatment.

According to scientists, numerous clinical variables have been implicated, however, the strongest predictor is the loss-of-function CYP2C19*2 allele (rs4244285), which is a common genetic variant that occurs in almost 30% of western Europeans and in about 50% of Asians.

Two unique P2Y12 inhibitors are prasugrel and ticagrelor, which compared with clopidogrel provide a more potent platelet inhibition. Although both drugs reduce major adverse cardiovascular events following acute coronary syndrome, they are also linked to higher complications in terms of bleeding. The researchers point out that retrospective genetic studies demonstrated that both, prasugrel and ticagrelor remained unaffected by the CYP2C19*2 allele. According to the authors, personalization of dual antiplatelet therapy after PCI could successfully minimize major adverse cardiovascular and adverse bleeding events if CYP2C19*2 carrier status could be identified in the future.

Spartan Biosciences in Ottawa, ON, Canada, has developed Spartan RX CYP2C19 as a point-of-care genetic test for the CYP2C19*2 allele that is performed with a buccal swab, which enables health-care personnel with no previous training in genetic laboratory techniques to undertake genotyping at the patient’s bedside.

The researchers decided to evaluate the clinical feasibility and pharmacodynamic efficacy of personalized dual antiplatelet therapy in patients who receive PCI treatment for acute coronary syndrome and stable coronary artery disease.

The standard care for these patients is a medical regimen of aspirin and clopidogrel, however, the new genetic test means that physicians can personalize the patient’s therapy and select whether they should opt to administer a more potent anti-platelet drug like prasugrel to those patients who have a high risk of failing treatment with clopidogrel.

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