CLINICAL REVIEW CLINICIAN’S CORNER CYP2C19 Genotype, Clopidogrel Metabolism, Platelet Function, and Cardiovascular Events A Systematic Review and Meta-analysis Michael V. Holmes, MBBS, MSc Context The US Food and Drug Administration recently recommended that CYP2C19 Pablo Perel, PhD genotyping be considered prior to prescribing clopidogrel, but the American Heart As- sociation and American College of Cardiologists have argued evidence is insufficient Tina Shah, PhD to support routine CYP2C19 genotype testing. Aroon D. Hingorani, PhD Objective To appraise evidence on the association of CYP2C19 genotype and clopi- Juan P. Casas, PhD dogrel response through systematic review and meta-analysis. Data Sources PubMed and EMBASE from their inception to October 2011. LOPIDOGREL IS AN ANTI - Study Selection Studies that reported clopidogrel metabolism, platelet reactivity platelet drug used by or clinically relevant outcomes (cardiovascular disease [CVD] events and bleeding), approximately 40 million 1,2 and information on CYP2C19 genotype were included. Cpatients worldwide to treat or prevent atherothrombotic Data Extraction We extracted information on study design, genotyping, and dis- ease outcomes and investigated sources of bias. events and after percutaneous coro- nary revascularization. An overview of Results We retrieved 32 studies of 42 016 patients reporting 3545 CVD events, 579 randomized trials including 7384
JAMA – American Medical Association
Published: Dec 28, 2011
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