Anti-platelet drugs, pharmacogenomics and stent thrombosis: What’s new?

Stent thrombosis is a catastrophic complication of percutaneous coronary intervention (PCI) and is associated with a mortality of 25 to 40%. The perception that stent thrombosis is very low in all patients has resulted in a lack of adherence to professional guidelines. New data to identify patients...

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Autor principal:	John Benjamin
Formato:	article
Lenguaje:	EN
Publicado:	South African Heart Association 2017
Materias:	anti-platelet drugs pharmacogenomics stent thrombosis Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/30784cb229da45439b3270debb1493bc
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spelling	oai:doaj.org-article:30784cb229da45439b3270debb1493bc2021-11-26T13:07:42ZAnti-platelet drugs, pharmacogenomics and stent thrombosis: What’s new?10.24170/7-3-19431996-67412071-4602https://doaj.org/article/30784cb229da45439b3270debb1493bc2017-04-01T00:00:00Zhttps://www.journals.ac.za/index.php/SAHJ/article/view/1943https://doaj.org/toc/1996-6741https://doaj.org/toc/2071-4602Stent thrombosis is a catastrophic complication of percutaneous coronary intervention (PCI) and is associated with a mortality of 25 to 40%. The perception that stent thrombosis is very low in all patients has resulted in a lack of adherence to professional guidelines. New data to identify patients at increased risk for stent thrombosis are emerging. Clopidogrel is a prodrug and the activation of clopidogrel is dependent on CY2C19. Numerous alleles of CYP2C19 exist. The allele CYP2CP2 has been associated with a marked decrease in platelet responsiveness to clopidogrel. Heterozygote carriers of the CYP2C192 have a 2.7 fold increased risk and homozygotes a 4.8 fold increased risk of stent thrombosis. Prospective randomised clinical trials will be necessary to determine the efficacy of CYP2C19 genotype directed therapy in evidence-based clinical decision making. Point-of-care platelet-function tests are becoming available and some centres are now performing such tests on their PCI patients. The most recent AHA/ACC /SCAI guidelines recommend testing for clopidogrel responsiveness in patients at high risk of subacute stent thrombosis and recommend increasing the dose of clopidogrel in non-responders.John BenjaminSouth African Heart Associationarticleanti-platelet drugspharmacogenomicsstent thrombosisDiseases of the circulatory (Cardiovascular) systemRC666-701ENSA Heart Journal, Vol 7, Iss 3, Pp 150-153 (2017)
institution	DOAJ
collection	DOAJ
language	EN
topic	anti-platelet drugs pharmacogenomics stent thrombosis Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	anti-platelet drugs pharmacogenomics stent thrombosis Diseases of the circulatory (Cardiovascular) system RC666-701 John Benjamin Anti-platelet drugs, pharmacogenomics and stent thrombosis: What’s new?
description	Stent thrombosis is a catastrophic complication of percutaneous coronary intervention (PCI) and is associated with a mortality of 25 to 40%. The perception that stent thrombosis is very low in all patients has resulted in a lack of adherence to professional guidelines. New data to identify patients at increased risk for stent thrombosis are emerging. Clopidogrel is a prodrug and the activation of clopidogrel is dependent on CY2C19. Numerous alleles of CYP2C19 exist. The allele CYP2CP2 has been associated with a marked decrease in platelet responsiveness to clopidogrel. Heterozygote carriers of the CYP2C192 have a 2.7 fold increased risk and homozygotes a 4.8 fold increased risk of stent thrombosis. Prospective randomised clinical trials will be necessary to determine the efficacy of CYP2C19 genotype directed therapy in evidence-based clinical decision making. Point-of-care platelet-function tests are becoming available and some centres are now performing such tests on their PCI patients. The most recent AHA/ACC /SCAI guidelines recommend testing for clopidogrel responsiveness in patients at high risk of subacute stent thrombosis and recommend increasing the dose of clopidogrel in non-responders.
format	article
author	John Benjamin
author_facet	John Benjamin
author_sort	John Benjamin
title	Anti-platelet drugs, pharmacogenomics and stent thrombosis: What’s new?
title_short	Anti-platelet drugs, pharmacogenomics and stent thrombosis: What’s new?
title_full	Anti-platelet drugs, pharmacogenomics and stent thrombosis: What’s new?
title_fullStr	Anti-platelet drugs, pharmacogenomics and stent thrombosis: What’s new?
title_full_unstemmed	Anti-platelet drugs, pharmacogenomics and stent thrombosis: What’s new?
title_sort	anti-platelet drugs, pharmacogenomics and stent thrombosis: what’s new?
publisher	South African Heart Association
publishDate	2017
url	https://doaj.org/article/30784cb229da45439b3270debb1493bc
work_keys_str_mv	AT johnbenjamin antiplateletdrugspharmacogenomicsandstentthrombosiswhatsnew
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Anti-platelet drugs, pharmacogenomics and stent thrombosis: What’s new?

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