Cover

Antiplatelet Therapy in ACS and A-Fib

Editor(s): Serebruany V.L. (Towson, Md.) 
Atar D. (Oslo) 
Table of Contents
Vol. 47, 2012
Section title: Paper
Serebruany VL, Atar D (eds): Antiplatelet Therapy in ACS and A-Fib. Adv Cardiol. Basel, Karger, 2012, vol 47, pp 100–113
(DOI:10.1159/000338043)

Genetic Considerations

Price M.J.
aCardiac Catheterization Laboratory, Division of Cardiovascular Diseases, Scripps Clinic, and bScripps Translational Science Institute, La Jolla, Calif., USA

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Article / Publication Details

First-Page Preview
Abstract of Paper

Published online: 8/9/2012
Cover Date: 2012

Number of Print Pages: 14
Number of Figures: 1
Number of Tables: 1

ISBN: 978-3-318-02168-4 (Print)
eISBN: 978-3-318-02169-1 (Online)

Abstract

Dual antiplatelet therapy with aspirin and a P2Y12 receptor antagonist improves outcomes in patients with acute coronary syndrome and in those treated with percutaneous coronary intervention (PCI) and a coronary stent. Candidate gene and genome-wide association studies have found that common genetic polymorphisms of the cytochrome P450 (CYP) 2C19 isoenzyme that result in a loss of functional activity are associated with less exposure of clopidogrel active metabolite and a diminished antiplatelet effect. Meta-analyses of registries and genetic substudies of randomized clinical trials demonstrate that carriers of these polymorphisms who are treated with clopidogrel are at an increased risk of cardiovascular events, particularly stent thrombosis, compared with noncarriers. This deleterious effect appears to be attenuated in patients not treated with PCI. The influence of polymorphisms of other genes, such as ABCB1, is inconsistent across clinical studies. The clinical efficacy of the newer P2Y12 antagonists prasugrel and ticagrelor do not appear to be affected by the CYP2C19 genotype, but these agents increase major bleeding not related to coronary artery bypass surgery. Although data from randomized clinical trials are currently lacking, these observations suggest that a pharmacogenomic-guided approach to antiplatelet therapy in acute coronary syndrome could potentially maximize ischemic benefit while minimizing bleeding risk.


Article / Publication Details

First-Page Preview
Abstract of Paper

Published online: 8/9/2012
Cover Date: 2012

Number of Print Pages: 14
Number of Figures: 1
Number of Tables: 1

ISBN: 978-3-318-02168-4 (Print)
eISBN: 978-3-318-02169-1 (Online)


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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