University of Rochester Medical Center
Institutional Affiliation: Geisinger Health Systems
NBER Working Papers and Publications
|May 2018||The Value of Cytochrome P450 2C19 Pharmacogenomic Information for Patients Receiving Clopidogrel Therapy following a Major Cardiovascular Event: Evidence from Geisinger|
with Rebecca A. Pulk, Jove Graham, Frank R. Lichtenberg, Marc S. Williams, Eric Wright
in Economic Dimensions of Personalized and Precision Medicine, Ernst Berndt, Dana Goldman, and John Rowe, editor
Dual antiplatelet therapy, combining a P2Y12 inhibitor and aspirin, is central to the management of patients with acute coronary syndromes. Clopidogrel is a commonly prescribed thienopyridine P2Y12 inhibitor used to prevent secondary events following a myocardial infarction / percutaneous coronary intervention. Clopidogrel effectiveness has been linked to proper function of metabolic enzyme cytochrome P450 2C19 (CYP2C19). Testing for CYP2C19 genetic changes that result in decreased activity has been proposed as a mechanism by which to identify clopidogrel non-responders a priori. Robust real-world studies evaluating the impact of genotype-guided antiplatelet selection on clinical, utilization and outcome metrics are lacking.
Approach: We linked clinical and financial data on a cohort of 2...