Abstract Details

Title Reduced CYP219 Clopidogrel Metabolism in a Multiethnic Population: Prevalance and Associated Rates of Recurrent Cerebrovascular Events

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P05 - (-)

Poster/Presentation
Number 220

Objective

Background BACKGROUND: Recently, concern has been raised over the possibility of reduced efficacy of clopidogrel due to genetic variations in CYP2C19 metabolism. An FDA black box warning recommends all patients be tested. It has been estimated that [sim] 3% (range 2-14%) of the population are poor metabolizers, with significant racial/ethnic variation, but little data is available for cerebrovascular patients.

Design/Methods DESIGN/METHODS: A retrospective review of all stroke and TIA patients tested for the clopidogrel CYP2C19 genotype from 4/2010 to 2/2012 was performed, with collection of data including race/ethnicity, CYP2C19 status, and presence of recurrent vascular events.

Results RESULTS: A total of 53 cerebrovascular patients were tested; consisting of 5.7% poor (n=3), 26.4% intermediate (n=14), 62.3% extensive (n=33), 3.8% indeterminate (n=2), and 1.9% "mixed ultra rapid and poor" (n=1) metabolizers. Only 10/38 Caucasians (26.3%) were intermediate or poor metabolizers, compared with 7/15 (46.7%) non-Caucasians. Of 43 patients treated with clopidogrel, 3/27 extensive metabolizers (11.1%) had recurrent cerebrovascular events or thrombosis compared with 33.3% of intermediate metabolizers (4/12), and 50% of poor metabolizers (1/2).

Conclusions CONCLUSIONS: These data suggest that the proportion of poor and intermediate clopidogrel metabolizers in cerebrovascular patients are comparable to cardiovascular studies, with a similarly higher prevalence of reduced metabolism, and potentially recurrent events, in non-Caucasian patients. Given the significant racial/ethnic differences, the large proportion of patients who are intermediate or poor metabolizers, and the need for long-term therapy with this medication, routine CYP2C19 testing of clopidogrel treated stroke/TIA patients, particularly in non-Caucasians, may be warranted. In addition, the emergence of generic clopidogrel could substantially increase usage, making this issue of even more importance.

Authors/Disclosures
Ilana Spokoyny, MD (Sutter West Bay Medical Group) PRESENTER	Dr. Spokoyny has nothing to disclose.
nobl barazangi, MD, PhD	Dr. Barazangi has nothing to disclose.
Victor Jaramillo, MD	No disclosure on file
Jeffrey A. Cohen, MD (Cleveland Clinic)	Dr. Cohen has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Convelo. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astoria. Dr. Cohen has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Bristol Myers Squibb. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Viatris. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for PSI. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Shionogi. Dr. Cohen has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Celltrion.
Jack C. Rose, MD (Washington Township Medical Group)	No disclosure on file
Charlene Chen, MD (Denali Therapeutics)	No disclosure on file
Christine S. Wong, MD	No disclosure on file
David C. Tong, MD, FAHA	No disclosure on file

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