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International Journal of Clinical Pharmacy

, Volume 35, Issue 4, pp 621–628 | Cite as

CYP2C19 genotypes and their impact on clopidogrel responsiveness in percutaneous coronary intervention

  • Melissa MejinEmail author
  • Wen Ni Tiong
  • Lana Yin Hui Lai
  • Lee Len Tiong
  • Adam Mohamad Bujang
  • Siaw San Hwang
  • Tiong Kiam Ong
  • Alan Yean Yip Fong
Research Article

Abstract

Background Cytochrome P450 2C19 (CYP2C19) loss-of-function polymorphisms are more common in Asian populations and have been associated with diminished antiplatelet response to clopidogrel. In this era of ‘personalised medicine’, combining genotyping and phenotyping as a strategy to personalise antiplatelet therapy warrants further exploration. Objective This study aimed to investigate the prevalence and impact of CYP2C19*2, *3 and *17 genotypes on clopidogrel responsiveness in a multiethnic Malaysian population planned for percutaneous coronary intervention. Setting Between October 2010 and March 2011, a total of 118 consecutive patients planned for percutaneous coronary intervention were enrolled in Sarawak General Hospital, Borneo. All patients received at least 75 mg aspirin daily for at least 2 days and 75 mg clopidogrel daily for at least 4 days prior to angiography. Method Genotyping for CYP2C19*2 (rs4244285, 681G > A), *3 (rs4986893, 636G > A) and *17 (rs11188072, −3402C > T) alleles were performed by polymerase chain reaction-restriction fragment linked polymorphism method. Whole blood ADP-induced platelet aggregation was assessed with multiple electrode platelet aggregometry (MEA) using the Multiplate Analyzer. Main outcome measures The distribution of CYP2C19*2, *3 and *17 among different ethnic groups and the association between genotype, clopidogrel responsiveness and clinical outcome were the main outcome measures. Results The highest prevalence of poor metabolisers (carriers of at least one copy of the *2 or *3 allele) was among the Chinese (53.7 %), followed by the Malays (26.9 %), Ibans (16.4 %) and other races (3.0 %). Poor metabolisers (PMs) had the highest mean MEA (303.6 AU*min), followed by normal metabolisers (NMs) with 270.5 AU*min and extensive metabolisers (EMs) with 264.1 AU*min (p = 0.518). Among poor responders to clopidogrel, 65.2 % were PMs and NMs, respectively, whereas none were EMs (p = 0.350). Two cardiac-related deaths were reported. Conclusion There was a diverse inter-ethnic difference in the distribution of CYP2C19 polymorphism. The findings of this study echo that of other studies where genotype appears to have a limited impact on clopidogrel responsiveness and clinical outcome in low-risk patients.

Keywords

Asian Clopidogrel CYP2C19 Genotyping Malaysia Multiethnic Platelet aggregation Polymorphism 

Notes

Acknowledgments

The authors would like to thank all study participants, physicians, pharmacists, research officers and nurses for their contribution to this study. The authors would also like to thank the reviewers for their invaluable comments and suggestions on the manuscript.

Funding

This study was supported by a grant from the Ministry of Health of Malaysia.

Conflicts of interest

The authors have no conflicts of interest to declare.

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Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Melissa Mejin
    • 2
    • 3
    Email author
  • Wen Ni Tiong
    • 1
    • 3
  • Lana Yin Hui Lai
    • 2
    • 3
  • Lee Len Tiong
    • 2
    • 3
  • Adam Mohamad Bujang
    • 5
  • Siaw San Hwang
    • 4
  • Tiong Kiam Ong
    • 1
  • Alan Yean Yip Fong
    • 1
    • 3
  1. 1.Department of CardiologySarawak General Hospital Heart CentreKota SamarahanMalaysia
  2. 2.Department of PharmacySarawak General Hospital Heart CentreKota SamarahanMalaysia
  3. 3.Clinical Research CentreSarawak General HospitalKuching, SarawakMalaysia
  4. 4.School of Engineering, Computing and ScienceSwinburne University of TechnologyKuchingMalaysia
  5. 5.Clinical Research CentreKuala LumpurMalaysia

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