Efficacy and Adverse Events of Clopidogrel and Ticagrelor in Patients with Cytochrome P450 2C19 Gene Deletion

To compare the safety and efficacy of clopidogrel and ticagrelor among patients with cytochrome P450 2C19*2 and *3 mutations, and to assess the necessity of pharmacogenetic testing is the objective of the study. The study is a two-center retrospective, observational cohort study of 425 patients. Compare the differences of patients with different genotypes in the rehospitalization owing to original disease, major adverse cardiovascular events, initial readmission duration, frequency and all-cause mortality, dyspnea, minor hemorrhagic incidents, as well as significant hemorrhagic incidents. No significant differences were observed between the two groups in terms of rehospitalization incidence and duration due to the primary disease, recurrent myocardial infarction, revascularization, stent thrombosis, as well as ischemic stroke (p>0.05). Nevertheless, ticagrelor-treated patients experienced a higher incidence of dyspnea events compared to those treated with clopidogrel (43.1 % vs. 31.7 %, p=0.039). Furthermore, the incidence of minor bleeding was similar between both groups (6.6 % vs. 2.8 %, p=0.184) and no major bleeding events were reported. In patients with cytochrome P450 2C19 gene deletion, clopidogrel and ticagrelor have similar efficacy, but clopidogrel has less dyspnea. Therefore, there is no more benefit from replacing clopidogrel with ticagrelor.

Automated summary

The objective of this study is to compare the safety and efficacy of clopidogrel and ticagrelor among patients with cytochrome P450 2C19*2 and *3 mutations and assess the necessity of pharmacogenetic testing. It is a two-center retrospective, observational cohort study of 425 patients. The study found that there were no significant differences between the two groups in terms of rehospitalization incidence and duration due to the primary disease, recurrent myocardial infarction, revascularization, stent thrombosis, and ischemic stroke. However, ticagrelor-treated patients experienced a higher incidence of dyspnea events compared to those treated with clopidogrel.