Abstract 16889: Risk Factors for Bleeding Modify the Impact of CYP2C19 Genetic Test Results on Antiplatelet Drug Selection
Introduction: Our institution uses CYP2C19 genotype to enhance precision of antiplatelet drug selection in high risk patients following percutaneous coronary intervention (PCI). However, it is unknown whether clinical factors impact P2Y12 inhibitor selection when CYP2C19 genotype is known.
Methods: This single-center, retrospective cohort study included 903 patients undergoing PCI from July 2012-Dec 2013. Clinical factors, CYP2C19 genotype and medications were abstracted from the medical record. Elevated bleeding risk (composite) was defined as: age ≥75, weight <60 kg, prior stroke, current end-stage renal disease, prior bleeding event, or anticoagulant use. Predictors of P2Y12 inhibitor maintenance therapy (clopidogrel versus either prasugrel or ticagrelor) were identified by regression.
Results: Selection of clopidogrel (71.3%) was more common than prasugrel (25.8%) or ticagrelor (2.9%). CYP2C19 genotype was obtained in 636 patients (70.4%) with 191/636 (30%) carrying a loss-of-function (LOF) allele. Prasugrel or ticagrelor was prescribed in 136/191 (71.2%) LOF allele carriers. Clopidogrel was prescribed in 344/445 (77.3%) without a LOF allele. Several clinical factors were also significantly associated with P2Y12 inhibitor selection (Table). CYP2C19 genotype appeared to modify the association between bleeding risk and prasugrel/ticagrelor selection (OR 0.41 [0.22-0.79] in LOF carriers vs. OR 0.19 [0.09-0.34] in non-carriers; interaction P=0.080). The interaction was significant for age ≥75 (P=0.017) and weight <60kg (P=0.012).
Conclusions: P2Y12 inhibitor selection was associated with clinical factors and CYP2C19 genotype. Risk factors for bleeding appeared to impact use of the CYP2C19 genotype test result, suggesting that genotype, when available, is one of multiple factors considered when selecting a P2Y12 inhibitor in a real-world clinical setting. The impact of this strategy on outcomes requires further study.
Author Disclosures: V.B. Sriramoju: None. N. Varunok: None. L.A. Howell: None. A. Cervantes: None. M.J. Polasek: None. G.A. Stouffer: None. C.R. Lee: None.
- © 2016 by American Heart Association, Inc.