Based on CYP2C19 Genotype of Clopidogrel and Ticagrelor Treatment of Acute Coronary Syndromes Individualized Drug Analysis / 中国药学杂志

ABSTRACT

OBJECTIVE: To investigate the adverse events of CYP2C19 gene polymorphism on clopidogrel and ticagrelor in the treatment of acute coronary syndrome and provide reference for clinical individualized medication. METHODS: The total of 1 086 patients with acute coronary syndrome were selected as the subjects in the cardiovascular department of Zhengzhou Central Hospital Affiliated to Zhengzhou University from March 2015 to March 2018. The patients were grouped according to whether they agreed to do the CPY2C19 gene test or not. The patients who didn′t carry out CYP2C19 gene testing were given routine dosage(Group A,75 mg clopidogrel and 100 mg aspirin). The CYP2C19 genotype was detected by real-time fluorescence quantitative PCR for patients in group B,group C and group D. According to the genotype,patients were divided into three groupsgroup B(super fast metabolism and fast metabolism, 75 mg clopidogrel and 100 mg aspirin), group C(intermediate metabolism,150 mg clopidogrel dosage and 100 mg aspirin),group D(slow metabolism, 150 mg clopidogrel dosage and 100 mg aspirin or 180 mg ticagrelor and 100 mg aspirin). The incidence of major adverse events and minor adverse events were compared among the four groups. RESULTS: There was significant differences in the incidence of major adverse events and stent thrombosis among group A, group B, group C and group D(P<0.05). The incidence of stent thrombosis in group A was significantly higher than that in group B and group C, respectively(all P<0.05). There were significant differences in the incidence of target vessel reconstruction and cardiogenic readmission among the four groups (all P<0.05). The target vessel reconstruction in group A was significantly higher than that in group B and group C(P<0.01). The cardiogenic readmission in group A was significantly higher than that in group B, group C and group D(all P<0.01). Compared with group D1, the incidence of secondary adverse events,stent thrombosis,target vessel reconstruction and cardiogenic readmission in group D1 were significantly higher than those in group C(all P<0.05 ). Compared with D1 group, the incidence of cardiogenic readmission in group D1 was significantly higher than that in group D2 ( P<0.05 ), but the incidence of bleeding was high in group D2. CONCLUSION: The CPY2C19 gene detection for individualized administration to patients with acute coronary syndrome can significantly reduce the incidence of adverse events, which is of great guiding significance. It is necessary to pay attention to the occurrence of bleeding events for patients with ultra-fast metabolic.