Abstract
A 62-year-old presents with angina. He has been genotyped for a panel of drug metabolism enzymes through a direct-to-consumer genetics company. His results reveal a CYP2C19 *2/*2 genotype with a warning that poor metabolizers (PMs) may have “lack of therapeutic effect of clopidogrel (Plavix), resulting from failure to generate the active form of the drug.” Stress testing suggests significant ischemic burden with consequent need for percutaneous coronary intervention (PCI), possible stent placement, and antiplatelet therapy.
MeSH terms
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Angina Pectoris / therapy
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Angioplasty, Balloon, Coronary / methods
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Aryl Hydrocarbon Hydroxylases / genetics*
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Clopidogrel
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Cytochrome P-450 CYP2C19
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Exercise Test
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Genotype
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Humans
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Male
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Middle Aged
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Pharmacogenetics*
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Platelet Aggregation Inhibitors / metabolism
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Platelet Aggregation Inhibitors / therapeutic use*
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Ticlopidine / analogs & derivatives*
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Ticlopidine / metabolism
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Ticlopidine / therapeutic use
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Treatment Outcome
Substances
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Platelet Aggregation Inhibitors
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Clopidogrel
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Aryl Hydrocarbon Hydroxylases
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CYP2C19 protein, human
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Cytochrome P-450 CYP2C19
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Ticlopidine