Comparative analysis of point-of-care bedside cyp2c19-testing guided anti-platelet therapy versus conventional therapies for cardiovascular diseases: a systematic review and meta-analysis.

Genetic variation in CYP2C19 is linked to variable efficacy in antiplatelet therapies like clopidogrel. Patients with CYP2C19*2 and *3 loss of function alleles show reduced enzyme function, leading to lower active drug levels and higher risks of thromboembolic and cardiovascular events. Point-of-care CYP2C19 testing offers a personalized approach to antiplatelet therapy. We conducted a systematic review of literature assessing point-of-care CYP2C19 testing to individualize antiplatelet therapy in cardiovascular patients compared to standard therapies. The review followed PRISMA guidelines and identified 146 articles, of which 3 randomized controlled trials (RCTs) were comprised. The three studies included 6945 patients; 3483 received genotype-guided therapy, and 3462 received standard care. Efficacy and safety outcomes were compared between groups. Point-of-care genotype-guided therapy improved primary outcomes and lowered bleeding rates compared to conventional therapy. However, the benefit varied, with most trials demonstrating improved efficacy and safety outcomes of various statistical significance levels. Meta-analysis of pooled data (n = 3,424) showed a significant reduction in major adverse cardiovascular events (MACE) with point-of-care genotype-guided therapy (RR = 0.56, 95% CI 0.41-0.76, p = 0.0002; moderate heterogeneity I² = 48%) while bleeding outcomes did not differ significantly (RR = 0.74, 95% CI 0.35-1.56, p = 0.42; I² = 51%). PROSPERO registration (CRD42023378028).