The CYP2C19*2 allele is a common genetic variant that has been associated with a significantly increased risk of major cardiovascular events and stent thrombosis following percutaneous coronary intervention (PCI).\u00a0 In this study a novel point-of-care genetic test was used to identify carriers of the CYP2C19*2 allele and to tailor a pharmacogenetic appriach to dual antiplatelet treatment after PCI.<\/p>\n
200 patients were enrolled into this prospective, randomised study.\u00a0 Patients undergoing PCI either electively or following an acute coronary syndrome were randomised to either point-of-care genotyping or to standard treatment.\u00a0 Carriers of the CYP2C19*2 allele were given 10mg of prasugrel daily, whereas all other patients in the trial were give 75mg of clopidogrel daily.\u00a0 The primary endpoint was was the proportion of CYP2C19*2 carriers with high on-treatment platelet reactivity after 1 week of dual antiplatelet treatment.<\/p>\n
187 patients completed follow-up, 91 from the rapid genotyping group, and 96 receiving standard treatment; in each group 23 individuals carried at least one CYP2C19*2 allele.\u00a0 None of the 23 carriers in the rapid genotyping group had evidence of inadequate platelet inhibition after seven days, compared with seven (30%) who were given standard treatment (p=0.0092).\u00a0 The point-of-care genetic test had a sensitivity of 100% and a specificity of 99.3%.<\/p>\n
\u00a0Conclusions<\/strong>:<\/p>\n \u00a0This study shows the utility of point-of-care genetic testing at the bedside and shows that treatment of identified CYP2C19*2 carriers with prasugrel can reduce high on-treatment platelet reactivity.<\/p>\n