CPIC 2022 Update: CYP2C19 Genotype Now Drives Broader Antiplatelet Therapy Recommendations for Clopidogrel
The updated CPIC guideline strengthens the recommendation for CYP2C19 genotype-guided clopidogrel prescribing, expanding indications beyond acute coronary syndrome and upgrading the recommendation strength for intermediate metabolizers. CYP2C19 poor and intermediate metabolizers experience reduced clopidogrel bioactivation and increased cardiovascular risk, warranting alternative antiplatelet agents. This guideline provides laboratories with updated genotype-to-phenotype translation tables and directly supports clinical pharmacogenomic implementation programs.
The original study
Clinical Pharmacogenetics Implementation Consortium Guideline for CYP2C19 Genotype and Clopidogrel Therapy: 2022 Update.
- Authors
- Lee CR, Luzum JA, Sangkuhl K, Gammal RS, Sabatine MS, Stein CM, et al.
- Journal
- Clinical pharmacology and therapeutics
- Type
- Journal Article, Research Support, N.I.H., Extramural, Practice Guideline
- PMID
- 35034351
Original abstract
CYP2C19 catalyzes the bioactivation of the antiplatelet prodrug clopidogrel, and CYP2C19 genotype impacts clopidogrel active metabolite formation. CYP2C19 intermediate and poor metabolizers who receive clopidogrel experience reduced platelet inhibition and increased risk for major adverse cardiovascular and cerebrovascular events. This guideline is an update to the 2013 Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for the use of clopidogrel based on CYP2C19 genotype and includes expanded indications for CYP2C19 genotype-guided antiplatelet therapy, increased strength of recommendation for CYP2C19 intermediate metabolizers, updated CYP2C19 genotype to phenotype translation, and evidence from an expanded literature review (updates at www.cpicpgx.org).