Bedside Genetic Testing Enables Tailored Antiplatelet Therapy

Tailored antiplatelet therapy, made possible through the novel point-of-care genetic test, optimized treatment for cardiac patients who carry the common genetic variant.

Use of the saliva swab test performed by nurses at the bedside of patients allowed doctors to almost instantly identify those with the genetic variant, known as CYP2C19*2, which puts them at risk of reacting poorly to standard antiplatelet drug therapy, and to administer an alternative drug.

A UOHI clinical trial known as RAPID GENE studied 200 patients undergoing coronary stent implantation for acute coronary syndrome or stable angina was carried out by scientists at the University of Ottawa Heart Institute (UOHI; Ottawa, ON, Canada). The trial demonstrated that tailored drug treatment therapy made possible by the genetic testing successfully protected all patients with the at-risk genetic variant from subsequent adverse events, while 30% of patients treated with standard therapy did not receive adequate protection.

About 25% of Caucasians and up to 40% of Asians have the genetic variant CYP2C19*2, which puts a patient at risk of not responding well to clopidogrel (Plavix), the standard antiplatelet drug given following stent procedures. Those tested who were found to carry the at-risk genetic variant were administered an alternative drug, prasugrel (Effient).

"These results are extremely promising, not only in the field of cardiology but for all areas of medicine. If you can administer a simple, rapid genetic test at the bedside, doctors can prescribe the right drug to the right patient at the right time. We then have a much greater chance of improving health outcomes and providing cost savings for the health care system," said Dr. Derek So, lead researcher for the study and Staff Interventional Cardiologist and Assistant Professor at the University of Ottawa Heart Institute.

The clinical trial findings were presented by Dr. So as a late-breaking clinical trial at the Transcatheter Cardiovascular Therapeutics 2011 conference which took place at the Moscone Center in San Francisco (CA, USA) from November 7-11, 2011. The forum for interventional cardiovascular medicine showcases the latest advances in current therapies and clinical research.

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University of Ottawa Heart Institute