Impact of CYP2C19 Genotype-guided Approach in Antiplatelet Therapy on Platelet Reactivity Index Among Coronary Artery Disease (CAD) Patients

Korábbi kezelés

• Patient with known CYP2C19 genotype prior to randomization
• Anticipated discontinuation of clopidogrel or ticagrelor within the 12 months follow up period (e.g. for elective surgery)
• Patient is receiving immunosuppressive therapy or has known immunosuppressive or autoimmune disease (e.g. human immunodeficiency virus, systemic lupus erythematous, etc.)
• Patient is receiving chronic anticoagulation therapy (i.e. vitamin K antagonist, direct thrombin inhibitor, Factor Xa inhibitor)
• Concomitant use of simvastatin/lovastatin >40 mg qd
• Concomitant use of potent CYP3A4 inhibitors (atazanavir, clarithromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin and voriconazole) or inducers (carbamazepine, dexamethasone, phenobarbital, phenytoin, rifampin, and rifapentine)

Más betegség

• Failure of index PCI
• History of ischaemic or haemorrhagic stroke
• History of allergies to aspirin, ticagrelor, or clopidogrel
• Suffering from HIV or any blood transmitted disease.
• Considered at high risk of bleeding*
• Stage 5 chronic kidney disease (CKD) based on the National Kidney Foundation, Kidney disease quality outcome initiative (KDQOI) definition (Levey et al., 2005), or those who were on haemodialysis
• Non-cardiac condition limiting life expectancy to less than a year, per judgement of physician

Egyéb

• Primary PCI or rescue PCI
• Any urgent/emergent coronary angiography procedure that would not allow for genetic testing to be performed before PCI
• Patient or physician refusal to enroll in the study
• Planned revascularization of any vessel within 30 days post-index procedure and/or of the target vessel(s) within 12 months post-procedure
• Pre-existing liver cirrhosis
• Pregnant women at any stage of gestation

• Males or females
• Aged between 18 to 80 years old
• Patients presents with stable CAD or acute coronary syndrome (ACS)
• Eligible for percutaneous coronary intervention (PCI)
• Willing to provide DNA sample via blood drawn for genotyping and platelet reactivity assessment
• Willing and able to provide informed written consent