Evidence map›Paper›PMID 33242107›Full record

Observational studyEuropean journal of clinical pharmacology2021

Implementation and management outcomes of pharmacogenetic CYP2C19 testing for clopidogrel therapy in clinical practice.

Stefan Russmann, Ali Rahmany, David Niedrig, Karl-Dietrich Hatz, Katja Ludin, Andrea M Burden, Lars Englberger, Roland Backhaus, Andreas Serra, Markus Béchir

Open access · hybridAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in European journal of clinical pharmacology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 2 pooled it
1.0field-weighted citation impact, top 20% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 2 syntheses or guidelines pooled it, 18 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
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  4. Article
  5. Article
  6. Review
  7. Association ofBalkan journal of medical genetics : BJMG · 2024
    Article
  8. Article
  9. Analysis ofBMJ open · 2021
    Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors at 4 institutions in 2 countries.

Stefan Russmanndrugsafety.ch, Seestrasse 221, 8700, Küsnacht, Switzerland. rustefan@ethz.ch.ORCID http://orcid.org/0000-0002-8943-9831
Ali Rahmanydrugsafety.ch, Seestrasse 221, 8700, Küsnacht, Switzerland.
David Niedrigdrugsafety.ch, Seestrasse 221, 8700, Küsnacht, Switzerland.
Karl-Dietrich HatzINTLAB AG, Zurich, Switzerland.
Katja LudinLabor Risch, Mocelular Genetics, Berne, Switzerland.
Andrea M BurdenPharmaceutical Sciences, Swiss Federal Institute of Technology Zurich (ETHZ), Zurich, Switzerland.
Lars EnglbergerCardiac Surgery, Clinic Hirslanden, Aarau, Switzerland.
Roland BackhausStroke Center and Clinic for Neurology, Clinic Hirslanden, Zurich, Switzerland.
Andreas SerraInstitute of Internal Medicine and Nephrology, Clinic Hirslanden, Zurich, Switzerland.
Markus BéchirCenter for Internal Medicine, Clinic Hirslanden, Aarau, Switzerland.
ETH Zurich · CHKlinik Hirslanden · CHHirslanden Klinik Aarau · CHLabormedizinische Zentrum Dr Risch (Switzerland) · CH

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThe antiplatelet prodrug clopidogrel is bioactivated by the polymorphic enzyme CYP2C19. Prospective clinical studies demonstrated an association between CYP2C19 loss of function (LoF) variants and an increased risk of thrombotic events under clopidogrel, but pharmacogenetic (PGx) testing is not frequently implemented in clinical practice. We report our experience with PGx-guided clopidogrel therapy with particular regard to clinically relevant patient management changes.

methodsWe conducted an observational study analyzing patients that underwent PGx testing for clopidogrel therapy at two Swiss hospitals. Primary outcome was the proportion of patients with clinically relevant PGx-based management recommendations and their implementation. The association of recurrent ischemic events under clopidogrel with CYP2C19 LoF variants and other factors was explored in a multivariate case-control analysis.

resultsAmong 56 patients undergoing PGx testing, 18 (32.1%) were classified as CYP2C19 intermediate or poor metabolizers. This resulted in 17 recommendations for a change of antiplatelet therapy, which were implemented in 12 patients (70.1%). In the remaining five patients, specific reasons for non-implementation could be identified. Recurrent ischemic events under clopidogrel were associated with LoF variants (OR 2.2, 95% CI 0.3-14.4) and several cardiovascular risk factors. Associations were not statistically significant in our small study, but plausible and in line with estimates from large prospective studies.

conclusionPGx-guided clopidogrel therapy can identify patients with an elevated risk of ischemic events and offer evidence-based alternative treatments. Successful implementation in clinical practice requires a personalized interdisciplinary service that evaluates indications and additional risk factors, provides specific recommendations, and proactively follows their implementation.

Indexed as

AgedAged, 80 and overCase-Control StudiesClopidogrelCytochrome P-450 CYP2C19FemaleGenotypeHeart Disease Risk FactorsHumansIschemiaMaleMiddle AgedPharmacogenomic TestingPlatelet Aggregation InhibitorsPolymorphism, Single NucleotidePrecision MedicineClopidogrelCytochrome P-450 CYP2C19Platelet Aggregation InhibitorsCardiologyClinical pharmacologyClopidogrelCYP2C19Pharmacogenetics

Identifiers

PMID33242107
PMCPMC8032605
OpenAlexW3106804278

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.