RT Journal
A1 Alexopoulos D, Xanthopoulou I
T1 CLopidogrel dosing based on genotype
JF JAMA
JO JAMA
YR 2012
FD March 14
VO 307
IS 10
SP 1024
OP 1025
DO 10.1001/jama.2012.281
UL http://dx.doi.org/10.1001/jama.2012.281
AB 
Platelet reactivity was assessed at least 1 month after myocardial infarction (MI), percutaneous coronary intervention (PCI), or both. However, it is well recognized that most events, including stent thrombosis, occur early, within 30 days of PCI. In the Platelet Inhibition and Patient Outcomes (PLATO) genetic substudy,2 the event rate at 30 days was higher in clopidogrel-treated patients with CYP2C19 alleles than those without CYP2C19 alleles, leading to earlier separation of event rates between the ticagrelor and clopidogrel groups in patients with loss-of-function alleles. In contrast, beyond 30 days, no difference in event rates between treatment groups for patients with any loss-of-function allele was observed. Therefore, genotyping and appropriate clopidogrel dose escalation outside the setting of MI and PCI may not provide incremental clinical utility.