Background The presence of the CYP2C19 loss of function *2 allele is associated with a decreased antiplatelet effect in clopidogrel treated patients. Since about 50% of major adverse cardiac events occur within the first 2 days post-percutaneous coronary intervention (PCI), a rapid CYP2C19*2 genotype result is important to individualise antiplatelet therapy at the start of treatment.
Purpose To apply a pharmacist led process to individualise antiplatelet therapy guided by CYP2C19*2 genotyping using the rapid point of care (POC) Spartan RX assay (Spartan Bioscience) in patients undergoing PCI.
Material and methods Following ethics approval and written informed consent, patients undergoing PCI with stent deployment for acute coronary syndrome or stable angina, and who were candidates for dual antiplatelet therapy, were recruited over a 3 month period by non-probability sampling. Exclusion criteria were patients <18 and >75 years old, body weight <60 kg, history of stroke or transient ischaemic attack, active bleeding, coagulation or platelet disorders, and/or chronic liver disease. A buccal sample was collected for automated CYP2C19*2 genotyping with the Spartan RX system within 1 h. Each patient was genotyped as a non-carrier of the *2 allele (*1/*1), a carrier of one *2 allele (*1/*2) or a carrier of two *2 alleles (*2/*2). Actionable genotypes (*1/*2, *2/*2) with therapy recommendations according to the 2013 Clinical Pharmacogenetics Implementation Consortium guidelines were communicated to the cardiologist.
Results The patient cohort consisted of 34 patients. 25 patients were male and 9 were female, mean age was 66 years (range 49–75) and all patients were Caucasian. 21 patients were genotyped as non-carriers of the *2 allele, 12 patients were genotyped as carriers of one *2 allele and 1 patient was genotyped as a carrier of two *2 alleles. For the 13 patients with an actionable genotype, the pharmacist discussed choice of antiplatelet therapy with the cardiologist since they were candidates for an alternative to clopidogrel.
Conclusion This POC assay was user friendly and rapidly identified carriers of the *2 allele. This study demonstrated the feasibility of this POC test to be implemented for pharmacist led CYP2C19*2 genotype guided individualisation of antiplatelet therapy during the critical period post-PCI.
References and/or Acknowledgements
University of Malta Faculty of Medicine and Surgery Dean’s Initiative, Technoline Ltd, Malta Heart Foundation, Orme Scientific Ltd
References and/or AcknowledgementsNo conflict of interest.
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