The role of CYP2C19 gene assay in antiplatelet therapy after off-pump coronary artery bypass grafting
10.3760/cma.j.issn.1001-4497.2019.01.011
- VernacularTitle:CYP2C19基因检测在非体外循环冠状动脉旁路移植术后抗血小板治疗的指导作用
- Author:
Hui HU
1
;
Changcheng LIU
;
Liangshan WANG
;
Wei SONG
;
Yang YU
;
Chengxiong GU
Author Information
1. 首都医科大学附属北京安贞医院心脏外科 100029
- Keywords:
CYP2C19 gene;
Clopidogrel;
Ticagrelor;
Coronary artery bypass grafting;
Platelet aggrega-tion rate
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2019;35(1):45-48
- CountryChina
- Language:Chinese
-
Abstract:
Objective To evaluate the guiding role of CYP2C19 gene assay in dual antiplatelet therapy(DAPT) after off-pump coronary artery bypass grafting ( OPCABG ) .Methods The patients who received scheduled OPCABG between May 2017 and May 2018 were recruited in this study.According to the results of CYP2C19 gene assay, the patients who carried CYP2C19 gene *2/*2,*2/*3 and*3/*3 mainly causing slow metabolism of clopidogrel were randomly divided into two groups: the clopidogrel group(patients receiving 100mg/qd aspirin plus 75mg/qd clopidogrel after surgery ), the ticagrelor group(patients receiving 100mg/qd aspirin plus 90mg/bid ticagrelor after surgery).Patients in the two groups underwent plate-let aggregation rate test first day before surgery and the 1, 4, 7 days antiplatelet therapy after surgery.And the major adverse cardiac events(MACE) was investigated 30 days after surgery in the two groups.Results A total of 244 patients were recrui-ted in the study with the clopidogrel group(n=122) and the ticagrelor group(n=122).The platelet aggregation rate after one day of postoperative DAPT in the ticagrelor group was lower than that in the clopidogrel group[(28.5 ±9.7)％ VS(51.8 ± 16.8)％, P<0.05].After 4 days of postoperative DAPT, platelet aggregation rate in the ticagrelor group maintained a stable and desired level.The MACE 30 days after surgery in the clopidogrel group and the ticagrelor group were 3.3％ and 1.6％ re-spectively, and ticagrelor plus aspirin reduced MACE in patients undergone coronary endarterectomy , P=0.043.Conclusion According to the results of CYP2C19 gene assay, ticagrelor replacing clopidogrel could shorten the duration of desired platelet aggregation rate in patients with DAPT after OPCABG , and may be reduce the risk of MACE after OPCABG and coronary end-arterectomy.
