CYP2C19 Genotype‐Guided Antiplatelet Therapy and Clinical Outcomes in Patients Undergoing a Neurointerventional Procedure
ABSTRACT In neurovascular settings, including treatment and prevention of ischemic stroke and prevention of thromboembolic complications after percutaneous neurointerventional procedures, dual antiplatelet therapy with a P2Y12 inhibitor and aspirin is the standard of care. Clopidogrel remains the mo...
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Wiley
2025-01-01
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| Series: | Clinical and Translational Science |
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| Online Access: | https://doi.org/10.1111/cts.70131 |
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| author | Kayla R. Tunehag Ashton F. Pearce Layna P. Fox George A. Stouffer Sten Solander Craig R. Lee |
| author_facet | Kayla R. Tunehag Ashton F. Pearce Layna P. Fox George A. Stouffer Sten Solander Craig R. Lee |
| author_sort | Kayla R. Tunehag |
| collection | DOAJ |
| description | ABSTRACT In neurovascular settings, including treatment and prevention of ischemic stroke and prevention of thromboembolic complications after percutaneous neurointerventional procedures, dual antiplatelet therapy with a P2Y12 inhibitor and aspirin is the standard of care. Clopidogrel remains the most commonly prescribed P2Y12 inhibitor for neurovascular indications. However, patients carrying CYP2C19 no‐function alleles have diminished capacity for inhibition of platelet reactivity due to reduced formation of clopidogrel's active metabolite. In patients with cardiovascular disease undergoing a percutaneous coronary intervention, CYP2C19 no‐function allele carriers treated with clopidogrel experience a higher risk of major adverse cardiovascular outcomes, and multiple large prospective outcomes studies have shown an improvement in clinical outcomes when antiplatelet therapy selection was guided by CYP2C19 genotype. Similarly, accumulating evidence has associated CYP2C19 no‐function alleles with poor clinical outcomes in clopidogrel‐treated patients in neurovascular settings. However, the utility of implementing a genotype‐guided antiplatelet therapy selection strategy in the setting of neurovascular disease and the clinical outcomes evidence in neurointerventional procedures remains unclear. In this review, we will (1) summarize existing evidence and guideline recommendations related to CYP2C19 genotype‐guided antiplatelet therapy in the setting of neurovascular disease, (2) evaluate and synthesize the existing evidence on the relationship of clinical outcomes to CYP2C19 genotype and clopidogrel treatment in patients undergoing a percutaneous neurointerventional procedure, and (3) identify knowledge gaps and discuss future research directions. |
| format | Article |
| id | doaj-art-d279f60702a3403ba9b696b203445ce6 |
| institution | Kabale University |
| issn | 1752-8054 1752-8062 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Clinical and Translational Science |
| spelling | doaj-art-d279f60702a3403ba9b696b203445ce62025-01-24T08:17:46ZengWileyClinical and Translational Science1752-80541752-80622025-01-01181n/an/a10.1111/cts.70131CYP2C19 Genotype‐Guided Antiplatelet Therapy and Clinical Outcomes in Patients Undergoing a Neurointerventional ProcedureKayla R. Tunehag0Ashton F. Pearce1Layna P. Fox2George A. Stouffer3Sten Solander4Craig R. Lee5Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy University of North Carolina at Chapel Hill Chapel Hill North Carolina USADivision of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy University of North Carolina at Chapel Hill Chapel Hill North Carolina USADivision of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy University of North Carolina at Chapel Hill Chapel Hill North Carolina USADivision of Cardiology, Department of Medicine, UNC School of Medicine University of North Carolina at Chapel Hill Chapel Hill North Carolina USADepartment of Radiology, UNC School of Medicine University of North Carolina at Chapel Hill Chapel Hill North Carolina USADivision of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy University of North Carolina at Chapel Hill Chapel Hill North Carolina USAABSTRACT In neurovascular settings, including treatment and prevention of ischemic stroke and prevention of thromboembolic complications after percutaneous neurointerventional procedures, dual antiplatelet therapy with a P2Y12 inhibitor and aspirin is the standard of care. Clopidogrel remains the most commonly prescribed P2Y12 inhibitor for neurovascular indications. However, patients carrying CYP2C19 no‐function alleles have diminished capacity for inhibition of platelet reactivity due to reduced formation of clopidogrel's active metabolite. In patients with cardiovascular disease undergoing a percutaneous coronary intervention, CYP2C19 no‐function allele carriers treated with clopidogrel experience a higher risk of major adverse cardiovascular outcomes, and multiple large prospective outcomes studies have shown an improvement in clinical outcomes when antiplatelet therapy selection was guided by CYP2C19 genotype. Similarly, accumulating evidence has associated CYP2C19 no‐function alleles with poor clinical outcomes in clopidogrel‐treated patients in neurovascular settings. However, the utility of implementing a genotype‐guided antiplatelet therapy selection strategy in the setting of neurovascular disease and the clinical outcomes evidence in neurointerventional procedures remains unclear. In this review, we will (1) summarize existing evidence and guideline recommendations related to CYP2C19 genotype‐guided antiplatelet therapy in the setting of neurovascular disease, (2) evaluate and synthesize the existing evidence on the relationship of clinical outcomes to CYP2C19 genotype and clopidogrel treatment in patients undergoing a percutaneous neurointerventional procedure, and (3) identify knowledge gaps and discuss future research directions.https://doi.org/10.1111/cts.70131clopidogrelCYP2C19percutaneous neurointerventional procedurespharmacogenomicsprecision medicinestroke |
| spellingShingle | Kayla R. Tunehag Ashton F. Pearce Layna P. Fox George A. Stouffer Sten Solander Craig R. Lee CYP2C19 Genotype‐Guided Antiplatelet Therapy and Clinical Outcomes in Patients Undergoing a Neurointerventional Procedure Clinical and Translational Science clopidogrel CYP2C19 percutaneous neurointerventional procedures pharmacogenomics precision medicine stroke |
| title | CYP2C19 Genotype‐Guided Antiplatelet Therapy and Clinical Outcomes in Patients Undergoing a Neurointerventional Procedure |
| title_full | CYP2C19 Genotype‐Guided Antiplatelet Therapy and Clinical Outcomes in Patients Undergoing a Neurointerventional Procedure |
| title_fullStr | CYP2C19 Genotype‐Guided Antiplatelet Therapy and Clinical Outcomes in Patients Undergoing a Neurointerventional Procedure |
| title_full_unstemmed | CYP2C19 Genotype‐Guided Antiplatelet Therapy and Clinical Outcomes in Patients Undergoing a Neurointerventional Procedure |
| title_short | CYP2C19 Genotype‐Guided Antiplatelet Therapy and Clinical Outcomes in Patients Undergoing a Neurointerventional Procedure |
| title_sort | cyp2c19 genotype guided antiplatelet therapy and clinical outcomes in patients undergoing a neurointerventional procedure |
| topic | clopidogrel CYP2C19 percutaneous neurointerventional procedures pharmacogenomics precision medicine stroke |
| url | https://doi.org/10.1111/cts.70131 |
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