Potential Usefulness of Clopidogrel Pharmacogenetics in Ce rebral Endovascular Procedures and Carotid Artery Stenting

Title:Potential Usefulness of Clopidogrel Pharmacogenetics in Ce rebral Endovascular Procedures and Carotid Artery Stenting

Volume: 12 Issue: 1

Author(s): Jorge Duconge*Dagmar F. Hernandez-Suarez

Affiliation:

• Department of Pharmaceutical Sciences, University of Puerto Rico Medical Sciences Campus, School of Pharmacy, Room 325-14, PO Box 365067; San Juan, PR 00936-5067,United States

Keywords: Clopidogrel, pharmacogenetics, CYP2C19, ischemic stroke, cerebral endovascular procedures, carotid artery stenting.

Abstract: Background: Previous reports have shown inadequate response to dual antiplatelet therapy (DAPT) with aspirin and clopidogrel in 5-30% of patients undergoing percutaneous coronary interventions (PCI), due mostly to clopidogrel resistance. This prevalence increases up to 66% in patients undergoing neurointerventional procedures. However, clinical significance of CYP2C19 genotypes in neurointerventional procedures or carotid artery stenting (CAS) is unknown.

Objective: The purpose of this review is to update our current knowledge and understanding of the pharmacogenetic basis for poor clopidogrel responsiveness in patients undergoing CAS and endovascular interventions as well as to explore usefulness of genotyping to reduce the rate of procedure-related thrombosis that results in ischemic complications.

Method: A literature search for pharmacogenetic studies in cerebral endovascular interventions and CAS was conducted on three databases using a list of the most relevant pharmacogenetic biomarkers.

Results: The review included 7 papers involving 3 genetic polymorphisms on CYP2C19 and 442 subjects. Patients harboring at least one loss-of-function CYP2C19 polymorphism (e.g., CYP2C19*2 and *3) are at an increased risk of thromboembolic complications such as stent thrombosis following neurointerventional procedures. Notably, patients who carry the gain-of-function CYP2C19*17 allele may have increased risk of ischemic events following endovascular treatment, independent of clopidogrel responsiveness.

Conclusion: Studies assessing the influence of CYP2C19 polymorphisms on high on-treatment platelet reactivity in CAS and cerebrovascular disease patients are still limited and need further validation in large multicenter studies. This review covers an important topic in the field of antiplatelet therapy for cerebral endovascular procedures and CAS.

Cite this article as:

Duconge Jorge*, Hernandez-Suarez F. Dagmar, Potential Usefulness of Clopidogrel Pharmacogenetics in Ce rebral Endovascular Procedures and Carotid Artery Stenting, Current Clinical Pharmacology 2017; 12 (1) . https://dx.doi.org/10.2174/1574884712666170227154654

DOI https://dx.doi.org/10.2174/1574884712666170227154654	Print ISSN 1574-8847
Publisher Name Bentham Science Publisher	Online ISSN 2212-3938