Clopidogrel in noncarriers of CYP2C19 loss-of-function alleles versus ticagrelor in elderly patients with acute coronary syndrome: A pre-specified sub analysis from the POPular Genetics and POPular Age trials CYP2C19 alleles in elderly patients
| العنوان: | Clopidogrel in noncarriers of CYP2C19 loss-of-function alleles versus ticagrelor in elderly patients with acute coronary syndrome: A pre-specified sub analysis from the POPular Genetics and POPular Age trials CYP2C19 alleles in elderly patients |
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| المؤلفون: | Michiel Voskuil, J. Wouter Jukema, Arnoud W J van 't Hof, Ton Heestermans, Gerrit J.A. Vos, Pim van der Harst, Richard M. Tjon Joe Gin, Marieke E. Gimbel, Sjoerd H. Hofma, A. Mosterd, Clemens von Birgelen, Jurriën M. ten Berg, Evelyn A. de Vrey, Folkert W. Asselbergs, Emanuele Barbato, Vera H.M. Deneer, Renicus S Hermanides, Thomas O. Bergmeijer, Willem Dewilde, Jean-Paul R. Herrman, Carmine Morisco, Frank R. den Hartog, Daniel M.F. Claassens, Bakhtawar K. Mahmoodi, Reinier A. Waalewijn |
| المساهمون: | Claassens, D. M. F., Gimbel, M. E., Bergmeijer, T. O., Vos, G. J. A., Hermanides, R. S., van der Harst, P., Barbato, E., Morisco, C., Tjon Joe Gin, R. M., de Vrey, E. A., Heestermans, T. A. C. M., Jukema, J. W., von Birgelen, C., Waalewijn, R. A., Hofma, S. H., den Hartog, F. R., Voskuil, M., van't Hof, A. W. J., Asselbergs, F. W., Mosterd, A., Herrman, J. -P. R., Dewilde, W., Mahmoodi, B. K., Deneer, V. H. M., ten Berg, J. M., Cardiologie, MUMC+: MA Med Staf Spec Cardiologie (9), RS: Carim - H01 Clinical atrial fibrillation, RS: Carim - B04 Clinical thrombosis and Haemostasis, Cardiology, Cardiovascular Centre (CVC), Afd Pharmacoepi & Clinical Pharmacology, Pharmacoepidemiology and Clinical Pharmacology |
| المصدر: | International Journal of Cardiology, 334, 10-17. Elsevier Ireland Ltd International journal of cardiology, 334, 10-17. Elsevier Ireland Ltd International Journal of Cardiology, 334, 10-17. ELSEVIER IRELAND LTD International Journal of Cardiology, 334, 10. Elsevier Ireland Ltd. |
| سنة النشر: | 2021 |
| مصطلحات موضوعية: | Ticagrelor, P2Y12, 030204 cardiovascular system & hematology, 0302 clinical medicine, 80 and over, PRASUGREL, 030212 general & internal medicine, Myocardial infarction, Stroke, Genetics, Aged, 80 and over, Allele, OUTCOMES, Pharmacogenetic, Hazard ratio, DUAL ANTIPLATELET THERAPY, ABCB1, Clopidogrel, Treatment Outcome, Cardiology and Cardiovascular Medicine, medicine.drug, Human, Acute coronary syndrome, Genotyping, Genotype, Clopidogrel/therapeutic use, CYP2C19, 03 medical and health sciences, medicine, Humans, cardiovascular diseases, Acute Coronary Syndrome, Alleles, Aged, business.industry, Platelet Aggregation Inhibitor, cyp2c19, genotyping, myocardial infarction, older, p2y12, pharmacogenetics, aged, alleles, clopidogrel, cytochrome p-450 cyp2c19, genotype, humans, platelet aggregation inhibitors, ticagrelor, treatment outcome, acute coronary syndrome, medicine.disease, Acute Coronary Syndrome/diagnosis, Cytochrome P-450 CYP2C19, Older, Pharmacogenetics, Cytochrome P-450 CYP2C19/genetics, business, Platelet Aggregation Inhibitors |
| الوصف: | Background: Patients with acute coronary syndrome (ACS) who are carrying CYP2C19 loss-of-function alleles derive less benefit from clopidogrel treatment. Despite this, in elderly patients, clopidogrel might be preferred over more potent P2Y12 inhibitors due to a lower bleeding risk. Whether CYP2C19 genotype-guided antiplatelet treatment in the elderly could be of benefit has not been studied specifically.Methods: Patients aged 70 years and older with known CYP2C19*2 and *3 genotype were identified from the POPular Genetics and POPular Age trials. Noncarriers of loss-of-function alleles treated with clopidogrel were compared to patients, irrespective of CYP2C19 genotype, treated with ticagrelor and to clopidogrel treated carriers of loss-of-function alleles. We assessed net clinical benefit (all-cause death, myocardial infarction, stroke and Platelet Inhibition and Patient Outcomes (PLATO) major bleeding), atherothrombotic outcomes (cardiovascular & nbsp;death, myocardial infarction, stroke) and bleeding outcomes (PLATO major and minor bleeding).Results: A total of 991 patients were assessed. There was no significant difference in net clinical benefit (17.2% vs. 15.1%, adjusted hazard ratio (adjHR) 1.05, 95% confidence interval (CI) 0.77 & ndash;1.44), atherothrombotic outcomes (9.7% vs. 9.2%, adjHR 1.00, 95%CI 0.66 & ndash;1.50), and bleeding outcomes (17.7% vs. 19.8%, adjHR 0.80, 95%CI 0.62 & ndash;1.12) between clopidogrel in noncarriers of loss-of-function alleles and ticagrelor respectively.Conclusion: In ACS patients aged 70 years and older, there was no significant difference in net clinical benefit and atherothrombotic outcomes between noncarriers of a loss-of-function allele treated with clopidogrel and pa-tients treated with ticagrelor. The bleeding rate was numerically; though not statistically significant, lower in pa-tients using clopidogrel.(c) 2021 Published by Elsevier B.V. |
| وصف الملف: | application/pdf |
| اللغة: | English |
| تدمد: | 0167-5273 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a7cc27e8784270e89ec58851d8398315Test https://hdl.handle.net/1874/415888Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....a7cc27e8784270e89ec58851d8398315 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 01675273 |
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