In a step toward personalized medicine, researchers are reporting that the use of genetic testing to guide selection of blood thinner medication led to a 34% decrease in the number of patients who had serious adverse events following balloon angioplasty, a common treatment for heart disease.
Clopidogrel is the most used antiplatelet or anti-clotting drug, but almost one-third of Americans carry variants in the CYP2C19 gene that interfere with the metabolism of clopidogrel. These patients are in a high-risk category due to their genetic makeup, but they can be identified with a simple genetic test. Patients who have the CYP2C19 gene variants may be good candidates for alternative anti-platelet therapy, the researchers said.
Called the TAILOR-PCI trial, the study enrolled 5,302 patients who had been treated for artery blockage with one or more stents and followed them for one year. Half of the group was randomized to be tested for the CYP2C19 gene variation and the carriers (35%) were treated with the alternative anti-platelet medication, ticagrelor. The remainder of the group was given clopidogrel, as was the entire other randomized half that consisted of the control group of patients who did not receive genetic testing.
The results showed a statistically not significant 34% reduction in serious adverse cardiovascular events, such as heart attack or stroke, in the loss of function CYP2C19 gene carrier patients assigned to ticagrelor in the genotype-guided group.
“The TAILOR-PCI trial is an example of the rigorous testing needed to explore personalized, genetic-guided treatment and whether it can improve patients’ outcomes," says Yves Rosenberg, M.D. “The results suggest potential value of a personalized, pharmacogenomic approach to the management of patients with heart disease undergoing coronary stenting." Dr. Rosenberg leads the National Heart, Lung, and Blood Institute's Atherothrombosis and Coronary Artery Disease Branch and is a co-author on the study. The study, funded in part by NHLBI, appeared in the Journal of the American Medical Association.