Testing of CYP2C19 variants and platelet reactivity for guiding antiplatelet treatment

Dahabreh IJ, Moorthy D, Lamont JL, Chen ML, Kent DM, Lau J
Record ID 32013000715
Authors' objectives: This comparative effectiveness review evaluated the analytic validity, prognostic value, and comparative effectiveness of two types of medical tests (genetic testing for CYP2C19 variants and phenotypic testing to measure platelet reactivity) to identify patients who are most likely to benefit from clopidogrel-based antiplatelet therapy and to guide antiplatelet therapy in patient populations who are eligible to receive or are already receiving clopidogrel treatment.
Authors' recommendations: We found evidence to support an association between loss-of-function CYP2C19 variants and increased risk of adverse cardiovascular outcomes. Similarly, we found evidence that high on-clopidogrel platelet reactivity is associated with an increased risk of adverse cardiovascular outcomes, at least for some of the available assays. The strength of evidence regarding these prognostic effects was judged to be low or moderate because of concerns regarding selective outcome reporting and publication bias, and the relatively small number of studies reporting data on most clinical outcomes. The strength of evidence regarding the use of genetic or platelet reactivity testing to guide antiplatelet treatment selection was judged to be insufficient because studies reporting on clinical outcomes were few, had diverse designs, and included heterogeneous populations. Comparative data on alternative test strategies (genetic versus phenotypic) are lacking.
Project Status: Completed
Year Published: 2013
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: United States
MeSH Terms
  • Humans
  • Polymorphism, Single Nucleotide
  • Platelet Activation
  • Platelet Aggregation Inhibitors
Organisation Name: Agency for Healthcare Research and Quality
Contact Address: Center for Outcomes and Evidence Technology Assessment Program, 540 Gaither Road, Rockville, MD 20850, USA. Tel: +1 301 427 1610; Fax: +1 301 427 1639;
Contact Name: martin.erlichman@ahrq.hhs.gov
Contact Email: martin.erlichman@ahrq.hhs.gov
Copyright: Agency for Healthcare Research and Quality (AHRQ)
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