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<meta name="keywords" content="C2674941, clopidogrel response, clopidogrel, poor metabolism of, cyp2c19, finding, plavix response, autosomal dominant, autosomal recessive, birth defects, chromosomal disease, chromosome, clinical features, clinical findings, clinical genetics, clinical recommendations, clinvar, congenital chromosomal disease, consumer genetic resources, cytogenetic location, disease characteristics, disease definitions, disease descriptions, disease ontology, disease synonyms, disease vocabulary, dysmorphology, entrez, familial disease, gene, gene-disease relationship, genereviews, genetic disease, genetic disorder, genetic terminology, genetic testing registry, genetics home reference, genomic disease, gtr, hereditary disease, heritable disease, hpo, human phenotype ontology, inherited disease, management guidelines, maternal inheritance, medgen, medical genetics, medical subject headings, mesh, mitochondrial inheritance, mode of inheritance, national center for biotechnology information, national institutes of health, national library of medicine, ncbi, nih, nlm, omim, ordo, orphanet, paternal inheritance, phenome, position statements, professional practice guidelines, rare disease, reference sequence, refseq, snomed ct, syndrome, undiagnosed diseases, x-linked recessive" /><meta name="description" content="Clopidogrel is a thienopyridine antiplatelet agent that prevents platelet activation and aggregation by irreversibly inhibiting the P2Y12 ADP receptors. As a prodrug, clopidogrel requires hepatic biotransformation to form an active metabolite. This conversion is composed of two sequential oxidative steps, which involve cytochrome P450-2C19 (CYP2C19) and other enzymes. Genetic variants in CYP2C19, along with other genetic and non-genetic factors, are known to influence variability in clopidogrel response. Specific CYP2C19 variants impair formation of active clopidogrel metabolites, which results in reduced platelet inhibition. CYP2C19 intermediate and poor metabolizers who receive clopidogrel experience an increased risk for major adverse cardiovascular and cerebrovascular events. Therapeutic recommendations for clopidogrel based on an individual’s CYP2C19 genotype have been published by the Clinical Pharmacogenetics Implementation Consortium (CPIC) and the 2022 guideline update includes new recommendations for CYP2C19 genotype-guided antiplatelet therapy." /><meta name="robots" content="index,nofollow,noarchive" />
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<!--
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UID=382487
|
||
ConceptID=C2674941
|
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-->
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<!--imgCountBooks = 0--><h1 class="medgenTitle"><div class="MedGenTitleText">Clopidogrel response</div></h1><div class="aux"><div class="resc"><dl class="rprtid"><dt>MedGen UID: </dt><dd>382487</dd><dt><span class="dotprefix"> •</span>Concept ID: </dt><dd><a href="/medgen/docs/help/#sources" target="_blank" title="Concept Unique Identifier from NLM's Unified Medical Language system (UMLS) Click for more information."><span class="highlight" style="background-color:">C2674941</span></a></dd><dt><span class="dotprefix"> •</span></dt><dd>Finding</dd></dl></div></div><table class="medgenTable"><tbody><tr><td>Synonyms:</td>
|
||
<td>Clopidogrel, poor metabolism of; Plavix response</td></tr>
|
||
<tr><td>Drug:</td>
|
||
<td>
|
||
<div class="divPopper rprt" id="drug_32948"><div><strong>Clopidogrel</strong><div class="aux"><div class="resc"><dl class="rprtid"><dt>MedGen UID: </dt><dd>32948</dd><dt><span class="dotprefix"> •</span>Concept ID: </dt><dd><a href="/medgen/docs/help/#sources" target="_blank" title="Concept Unique Identifier from NLM's Unified Medical Language system (UMLS) Click for more information.">C0070166</a></dd><dt><span class="dotprefix"> •</span></dt><dd>Pharmacologic Substance</dd></dl></div></div></div>
|
||
<div class="spaceAbove">A thienopyridine, with antiplatelet activity. Clopidogrel targets, irreversibly binds to and alters the platelet receptor for adenosine diphosphate (ADP), thereby blocking the binding of ADP to its receptor, inhibiting ADP-mediated activation of the glycoprotein complex GPIIb/IIIa, and inhibiting fibrinogen binding to platelets and platelet adhesion and aggregation. This results in increased bleeding time. [from NCI]</div></div>
|
||
<div class="hangingIndent"><a title="click for more information" class="jig-ncbipopper" href="#drug_32948" data-jigconfig="hasArrow: true, openEvent: 'click', closeEvent: 'mouseout', openAnimation: 'fadeIn', closeAnimation: 'fadeOut', triggerPosition: 'center right', destPosition: 'center left', arrowDirection: 'left'">Clopidogrel</a></div></td></tr>
|
||
<tr><td colspan="2" class="small"> </td></tr><tr><td><a class="help jig-ncbi-popper" data-jig="ncbipopper" href="#target-gene-loc">Gene (location):<img class="pulldown" src="//static.pubmed.gov/portal/portal3rc.fcgi/4223267/img/4204968" /></a><div class="display-none" id="target-gene-loc">
|
||
Gene(s) directly associated with<br />
|
||
this condition or phenotype.</div></td>
|
||
<td><a target="_blank" title="CYP2C19 - ID: 1557 - NCBI Gene" href="/gene/1557" class="medgenPMinfo">CYP2C19</a> (10q23.33)</td></tr>
|
||
<tr><td colspan="2" class="small"> </td></tr><tr><td>OMIM<span class="superscript">®</span>:</td>
|
||
<td><a href="https://omim.org/entry/124020" target="_blank">124020</a>; <a href="https://omim.org/entry/609535" target="_blank">609535</a></td></tr>
|
||
</tbody></table></div><div class="rprt-body jig-ncbiinpagenav" data-jigconfig="smoothScroll: false, gotoTopLink: true, gotoTopLinkText: '', gotoTopLinkAttrs: {'title': 'Go to the top of the page'},allHeadingLevels: ['h1'], topOfPageTOC: true, tocId: 'my-toc'"><div id="rprt-tabs-1" class="rprt-tab"><div id="tb-termsProp-1"><div class="leftCol mgCol"><div>
|
||
<div class="portlet mgSection" id="ID_100">
|
||
<div class="portlet_head mgSectionHead ui-widget-header"><h1 class="nl" id="Definition">Definition</h1><a sid="100" href="#" class="portlet_shutter" title="Show/hide content"></a></div>
|
||
<div class="portlet_content ln">Clopidogrel is a thienopyridine antiplatelet agent that prevents platelet activation and aggregation by irreversibly inhibiting the P2Y12 ADP receptors. As a prodrug, clopidogrel requires hepatic biotransformation to form an active metabolite. This conversion is composed of two sequential oxidative steps, which involve cytochrome P450-2C19 (CYP2C19) and other enzymes. Genetic variants in CYP2C19, along with other genetic and non-genetic factors, are known to influence variability in clopidogrel response. Specific CYP2C19 variants impair formation of active clopidogrel metabolites, which results in reduced platelet inhibition. CYP2C19 intermediate and poor metabolizers who receive clopidogrel experience an increased risk for major adverse cardiovascular and cerebrovascular events. Therapeutic recommendations for clopidogrel based on an individual’s CYP2C19 genotype have been published by the Clinical Pharmacogenetics Implementation Consortium (CPIC) and the 2022 guideline update includes new recommendations for CYP2C19 genotype-guided antiplatelet therapy. [from <a title="The Pharmacogenomics Knowledge Base" href="http://www.pharmgkb.org" class="defSource" target="_blank">PharmGKB</a>]</div>
|
||
</div>
|
||
|
||
<div class="portlet mgSection" id="ID_117">
|
||
<div class="portlet_head mgSectionHead ui-widget-header"><h1 class="nl" id="Additional_descriptions">Additional descriptions</h1><a sid="117" href="#" class="portlet_shutter" title="Show/hide content"></a></div>
|
||
<div class="portlet_content ln"><div class="mgSection"><strong>From Medical Genetics Summaries</strong><br />Clopidogrel is an antiplatelet medicine that reduces the risk of myocardial infarction (MI) and stroke in individuals with acute coronary syndrome (ACS), and in individuals with atherosclerotic vascular disease (indicated by a recent MI or stroke, or established peripheral arterial disease). Clopidogrel is also indicated in combination with aspirin for individuals undergoing percutaneous coronary interventions (PCI), including stent placement.
|
||
The effectiveness of clopidogrel depends on its conversion to an active metabolite, which is accomplished by the cytochrome P450 2C19 (CYP2C19) enzyme. Individuals who have 2 loss-of-function copies of the CYP2C19 gene are classified as CYP2C19 poor metabolizers (PM). Individuals with a CYP2C19 PM phenotype have significantly reduced enzyme activity and cannot activate clopidogrel via CYP2C19, which means the drug will have a reduced antiplatelet effect. Approximately 2% of Caucasians, 4% of African Americans, 14% of Chinese, and 57% of Oceanians are CYP2C19 PMs. The effectiveness of clopidogrel is also reduced in individuals who are CYP2C19 intermediate metabolizers (IM). These individuals have one loss-of-function copy of CYP2C19, with either one normal function copy or one increased function copy. The frequency of the IM phenotype is more than 45% in individuals of East Asian descent, more than 40% in individuals of Central or South Asian descent, 36% in the Oceanian population, approximately 30% in individuals of African descent, 20–26% in individuals of American, European, or Near Eastern descent, and just under 20% in individuals of Latino descent.
|
||
The 2022 FDA-approved drug label for clopidogrel includes a boxed warning on the diminished antiplatelet effect of clopidogrel in CYP2C19 PMs. The warning states that tests are available to identify individuals who are CYP2C19 PMs, and to consider the use of another platelet P2Y12 (purinergic receptor P2Y, G-protein coupled 12) inhibitor in individuals identified as CYP2C19 PMs.
|
||
The 2022 Clinical Pharmacogenetics Implementation Consortium (CPIC) guideline for clopidogrel recommends that for individuals with ACS or non-ACS indications who are undergoing PCI, being treated for peripheral arterial disease (PAD), or stable coronary artery disease following MI, an alternative antiplatelet therapy (for example, prasugrel or ticagrelor) should be considered for CYP2C19 PMs if there is no contraindication. Similarly, CPIC strongly recommends that CYP2C19 IMs should avoid clopidogrel for ACS or PCI but makes no recommendations for other cardiovascular indications. For neurovascular indications, CPIC recommends avoidance of clopidogrel for CYP2C19 PMs and consideration of alternative medications for both IMs and PMs if not contraindicated.
|
||
The Dutch Pharmacogenetics Working Group (DPWG) of the Royal Dutch Association for the Advancement of Pharmacy (KNMP) have also made antiplatelet therapy recommendations based on CYP2C19 genotype. For individuals with ACS who undergo PCI, they recommend an alternative antiplatelet agent in PMs, and for IMs they recommend choosing an alternative antiplatelet agent or doubling the dose of clopidogrel to 150 mg daily dose, 600 mg loading dose. <a target="_blank" href="https://www.ncbi.nlm.nih.gov/books/NBK84114">https://www.ncbi.nlm.nih.gov/books/NBK84114</a></div><div class="mgSection"><strong>From MedlinePlus Genetics</strong><br />Clopidogrel resistance is a condition in which the drug clopidogrel is less effective than normal in people who are treated with it. Clopidogrel (also known as Plavix) is an antiplatelet drug, which means that it prevents blood cells called platelets from sticking together (aggregating) and forming blood clots. This drug is typically given to prevent blood clot formation in individuals with a history of stroke; heart attack; a blood clot in the deep veins of the arms or legs (deep vein thrombosis); or plaque buildup (atherosclerosis) in the blood vessels leading from the heart, which are opened by placement of a small thin tube (stent).<br /><br />People with clopidogrel resistance who receive clopidogrel are at risk of serious, sometimes fatal, complications. These individuals may have another heart attack or stroke caused by abnormal blood clot formation; those with stents can develop blood clots (thromboses) within the stents, impeding blood flow.<br /><br />People with clopidogrel resistance can be divided into two categories: intermediate metabolizers and poor metabolizers. Intermediate metabolizers are able to process some clopidogrel, so they receive partial benefit from the treatment but are not protected from developing a harmful blood clot. Poor metabolizers process little or no clopidogrel, so they receive very limited benefit from the treatment and are at risk of forming a harmful blood clot.<br /><br />Clopidogrel resistance does not appear to cause any health problems other than those associated with clopidogrel drug treatment. <a target="_blank" href="https://medlineplus.gov/genetics/condition/clopidogrel-resistance">https://medlineplus.gov/genetics/condition/clopidogrel-resistance</a></div></div>
|
||
</div>
|
||
|
||
<div class="portlet mgSection" id="ID_105">
|
||
<div class="portlet_head mgSectionHead ui-widget-header"><h1 class="nl" id="Professional_guidelines">Professional guidelines</h1><a sid="105" href="#" class="portlet_shutter" title="Show/hide content"></a></div>
|
||
<div class="portlet_content ln"><h3 class="subhead">PubMed<a class="help jig-ncbi-popper" data-jig="ncbipopper" href="#guidelinesHelpPM"><img class="pulldown" src="//static.pubmed.gov/portal/portal3rc.fcgi/4223267/img/4204968" /></a></h3>
|
||
<div class="nl"><a target="_blank" href="/pubmed/38180321">Treatment of atrial fibrillation.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMjournal">Med Lett Drugs Ther</span>
|
||
2024 Jan 8;66(1693):1-8.
|
||
doi: 10.58347/tml.2024.1693a.
|
||
<span class="bold">PMID: </span><a href="/pubmed/38180321" target="_blank">38180321</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/33953382">Pharmacogenetics to guide cardiovascular drug therapy.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Duarte JD,
|
||
Cavallari LH</span><br />
|
||
<span class="medgenPMjournal">Nat Rev Cardiol</span>
|
||
2021 Sep;18(9):649-665.
|
||
Epub 2021 May 5
|
||
doi: 10.1038/s41569-021-00549-w.
|
||
<span class="bold">PMID: </span><a href="/pubmed/33953382" target="_blank">33953382</a><a href="/pmc/articles/PMC8364496" target="_blank" class="PubMedFree">Free PMC Article</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/32860058">2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Collet JP,
|
||
Thiele H,
|
||
Barbato E,
|
||
Barthélémy O,
|
||
Bauersachs J,
|
||
Bhatt DL,
|
||
Dendale P,
|
||
Dorobantu M,
|
||
Edvardsen T,
|
||
Folliguet T,
|
||
Gale CP,
|
||
Gilard M,
|
||
Jobs A,
|
||
Jüni P,
|
||
Lambrinou E,
|
||
Lewis BS,
|
||
Mehilli J,
|
||
Meliga E,
|
||
Merkely B,
|
||
Mueller C,
|
||
Roffi M,
|
||
Rutten FH,
|
||
Sibbing D,
|
||
Siontis GCM;
|
||
ESC Scientific Document Group</span><br />
|
||
<span class="medgenPMjournal">Eur Heart J</span>
|
||
2021 Apr 7;42(14):1289-1367.
|
||
doi: 10.1093/eurheartj/ehaa575.
|
||
<span class="bold">PMID: </span><a href="/pubmed/32860058" target="_blank">32860058</a></div>
|
||
<div><a target="_blank" href="https://pubmed.ncbi.nlm.nih.gov/?term=(%22clopidogrel%22%5Btiab%3A~0%5D)%20AND%20(%22english%20and%20humans%22%5BFilter%5D)%20AND%20(%20(%22practice%20guideline%22%5BFilter%5D)%20OR%20(practice*%5Btitl%5D%20AND%20(guideline%5Btitl%5D%20OR%20parameter%5Btitl%5D%20OR%20resource%5Btitl%5D%20OR%20bulletin%5Btitl%5D%20OR%20best%5Btitl%5D))%20OR%20(genetic*%5Btitl%5D%20AND%20(evaluation%5Btitl%5D%20OR%20counseling%5Btitl%5D%20OR%20screening%5Btitl%5D%20OR%20test*%5Btitl%5D))%20OR%20(clinical%5Btitl%5D%20AND%20((expert%5Btitl%5D%20AND%20consensus%5Btitl%5D)%20OR%20utility%5Btitl%5D%20OR%20guideline*%5Btitl%5D))%20OR%20(management%5Btitl%5D%20AND%20(clinical%5Btitl%5D%20OR%20diagnos*%5Btitl%5D%20OR%20recommendation%5Btitl%5D%20OR%20pain%5Btitl%5D%20OR%20surveillance%5Btitl%5D%20OR%20emergency%5Btitl%5D%20OR%20guideline*%5Btitl%5D%20OR%20therap*))%20OR%20(treatment%5Btitl%5D%20AND%20((evaluation%5Btitl%5D%20AND%20diagnosis%5Btitl%5D)%20OR%20(assessment%5Btitl%5D%20AND%20prevention%5Btitl%5D)%20OR%20therap*))%20OR%20(Diagnos*%5Btitl%5D%20AND%20(prenatal%5Btitl%5D%20OR%20treatment%5Btitl%5D%20OR%20follow-up%5Btitl%5D%20OR%20statement%5Btitl%5D%20OR%20criteria%5Btitl%5D%20OR%20newborn%5Btitl%5D%20OR%20differential%5Btitl%5D%20OR%20neonatal%5Btitl%5D%20OR%20neonate%5Btitl%5D))%20OR%20(guideline*%5Btitl%5D%20AND%20(pharmacogenetic*%5Btitl%5D%20OR%20recommendation%5Btitl%5D%20OR%20therap*%5Btitl%5D%20OR%20evidence-based%5Btitl%5D%20OR%20consensus%5Btitl%5D%20OR%20(technical%5Btitl%5D%20AND%20standard*%5Btitl%5D)%20OR%20(molecular%5Btitl%5D%20AND%20testing%5Btitl%5D)))%20OR%20(risk%5Btitl%5D%20AND%20assessment%5Btitl%5D)%20OR%20(recommendation*%5Btitl%5D%20AND%20(statement%5Btitl%5D%20OR%20Evidence-based%5Btitl%5D%20OR%20Consensus%5Btitl%5D))%20OR%20(care%20AND%20((Patient%5Btitl%5D%20AND%20standard*%5Btitl%5D)%20OR%20primary%5Btitl%5D%20OR%20psychosocial%5Btitl%5D))%20OR%20(Health%5Btitl%5D%20AND%20supervision%5Btitl%5D)%20OR%20(statement%5Btitl%5D%20AND%20(policy%5Btitl%5D%20OR%20position%5Btitl%5D%20OR%20Consensus%5Btitl%5D))%20OR%20(pharmacogenetics%5Btitl%5D%20AND%20(Dosing%5Btitl%5D%20OR%20therap*%5Btitl%5D%20OR%20genotype*%5Btitl%5D%20OR%20drug*%5Btitl%5D))%20OR%20(Chemotherapy%5Btitl%5D%20AND%20decision*%5Btitl%5D)%20OR%20(screening%5Btitl%5D%20AND%20(newborn%5Btitl%5D%20OR%20neonat*%5Btitl%5D%20OR%20detection%5Btitl%5D%20OR%20diagnos*%5Btitl%5D))%20OR%20(criteria%5Btitl%5D%20OR%20genotype*%5Btitl%5D)%20)%20NOT%20(%22Case%20reports%22%5BPublication%20type%5D%20OR%20%22clinical%20study%22%5BPublication%20Type%5D%20OR%20%22randomized%20controlled%20trial%22%5BPublication%20Type%5D)" title="PubMed search">See all (1214)</a></div><h3 class="subhead">Curated<a class="help jig-ncbi-popper" data-jig="ncbipopper" href="#guidelinesHelpCurated"><img class="pulldown" src="//static.pubmed.gov/portal/portal3rc.fcgi/4223267/img/4204968" /></a></h3><h3 class="nl vspace"><a href="https://www.knmp.nl/media/1058" target="_blank">Royal Dutch Pharmacists Association (KNMP). Dutch Pharmacogenetics Working Group (DPWG). Pharmacogenetic Recommendation.</a></h3>
|
||
</div>
|
||
</div>
|
||
<div class="display-none help-popup" id="guidelinesHelpPM">These guidelines are articles in PubMed that match specific search criteria developed by MedGen to capture the most relevant practice guidelines. This list may not be comprehensive and may include broader topics as well. See the <a href="/medgen/docs/faq/" title="Frequently asked questions" target="_blank">FAQ</a> for details.</div><div class="display-none help-popup" id="guidelinesHelpCurated">These guidelines are manually curated by the MedGen team
|
||
to supplement articles available in PubMed. See the <a href="/medgen/docs/faq/" title="Frequently asked questions" target="_blank">FAQ</a> for details.</div>
|
||
<div class="portlet mgSection" id="ID_114">
|
||
<div class="portlet_head mgSectionHead ui-widget-header"><h1 class="nl" id="Suggested_Reading">Suggested Reading</h1><a sid="114" href="#" class="portlet_shutter" title="Show/hide content"></a></div>
|
||
<div class="portlet_content ln"><h3 class="subhead">PubMed</h3>
|
||
<div class="nl"><a target="_blank" href="/pubmed/24946154">A systematic review and critical assessment of 11 discordant meta-analyses on reduced-function CYP2C19 genotype and risk of adverse clinical outcomes in clopidogrel users.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Osnabrugge RL,
|
||
Head SJ,
|
||
Zijlstra F,
|
||
ten Berg JM,
|
||
Hunink MG,
|
||
Kappetein AP,
|
||
Janssens AC</span><br />
|
||
<span class="medgenPMjournal">Genet Med</span>
|
||
2015 Jan;17(1):3-11.
|
||
Epub 2014 Jun 19
|
||
doi: 10.1038/gim.2014.76.
|
||
<span class="bold">PMID: </span><a href="/pubmed/24946154" target="_blank">24946154</a></div>
|
||
<div><a target="_blank" href="https://pubmed.ncbi.nlm.nih.gov/?term=" title="PubMed search"></a></div></div>
|
||
</div>
|
||
|
||
<div class="portlet mgSection" id="ID_103">
|
||
<div class="portlet_head mgSectionHead ui-widget-header"><h1 class="nl" id="Recent_clinical_studies">Recent clinical studies</h1><a sid="103" href="#" class="portlet_shutter" title="Show/hide content"></a></div>
|
||
<div class="portlet_content ln"><h3 class="subhead">Etiology</h3>
|
||
<div class="nl"><a target="_blank" href="/pubmed/36588476">Pharmacogenetics of P2Y(12) receptor inhibitors.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Thomas CD,
|
||
Williams AK,
|
||
Lee CR,
|
||
Cavallari LH</span><br />
|
||
<span class="medgenPMjournal">Pharmacotherapy</span>
|
||
2023 Feb;43(2):158-175.
|
||
Epub 2023 Jan 13
|
||
doi: 10.1002/phar.2758.
|
||
<span class="bold">PMID: </span><a href="/pubmed/36588476" target="_blank">36588476</a><a href="/pmc/articles/PMC9931684" target="_blank" class="PubMedFree">Free PMC Article</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/32732514">Clopidogrel response in patients receiving the nonvitamin K antagonist oral anticoagulants apixaban and rivaroxaban.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Gosetti R,
|
||
Sarafoff N,
|
||
Laugwitz KL,
|
||
Kastrati A,
|
||
Bernlochner I,
|
||
Goedel A</span><br />
|
||
<span class="medgenPMjournal">Coron Artery Dis</span>
|
||
2021 Mar 1;32(2):167-169.
|
||
doi: 10.1097/MCA.0000000000000933.
|
||
<span class="bold">PMID: </span><a href="/pubmed/32732514" target="_blank">32732514</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/30998396">Clopidogrel Pharmacogenetics.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Pereira NL,
|
||
Rihal CS,
|
||
So DYF,
|
||
Rosenberg Y,
|
||
Lennon RJ,
|
||
Mathew V,
|
||
Goodman SG,
|
||
Weinshilboum RM,
|
||
Wang L,
|
||
Baudhuin LM,
|
||
Lerman A,
|
||
Hasan A,
|
||
Iturriaga E,
|
||
Fu YP,
|
||
Geller N,
|
||
Bailey K,
|
||
Farkouh ME</span><br />
|
||
<span class="medgenPMjournal">Circ Cardiovasc Interv</span>
|
||
2019 Apr;12(4):e007811.
|
||
doi: 10.1161/CIRCINTERVENTIONS.119.007811.
|
||
<span class="bold">PMID: </span><a href="/pubmed/30998396" target="_blank">30998396</a><a href="/pmc/articles/PMC6581205" target="_blank" class="PubMedFree">Free PMC Article</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/28335443">Pharmacokinetic and Pharmacodynamic Responses to Clopidogrel: Evidences and Perspectives.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Zhang YJ,
|
||
Li MP,
|
||
Tang J,
|
||
Chen XP</span><br />
|
||
<span class="medgenPMjournal">Int J Environ Res Public Health</span>
|
||
2017 Mar 14;14(3)
|
||
doi: 10.3390/ijerph14030301.
|
||
<span class="bold">PMID: </span><a href="/pubmed/28335443" target="_blank">28335443</a><a href="/pmc/articles/PMC5369137" target="_blank" class="PubMedFree">Free PMC Article</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/28260523">Obesity and Inflammation and Altered Clopidogrel Pharmacokinetics and Pharmacodynamics.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Norgard NB,
|
||
Monte SV</span><br />
|
||
<span class="medgenPMjournal">Drug Metab Lett</span>
|
||
2017 Nov 17;11(1):3-13.
|
||
doi: 10.2174/1872312811666170301110349.
|
||
<span class="bold">PMID: </span><a href="/pubmed/28260523" target="_blank">28260523</a></div>
|
||
<div><a target="_blank" href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Clopidogrel%20response%22%20AND%20Etiology%2Fbroad%5Bfilter%5D%20%20AND%20%22english%20and%20humans%22%5Bfilter%5D%20NOT%20comment%5BPTYP%5D%20NOT%20letter%5BPTYP%5D" title="PubMed search">See all (207)</a></div><h3 class="subhead">Diagnosis</h3>
|
||
<div class="nl"><a target="_blank" href="/pubmed/31504375">Pharmacogenomic polygenic response score predicts ischaemic events and cardiovascular mortality in clopidogrel-treated patients.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Lewis JP,
|
||
Backman JD,
|
||
Reny JL,
|
||
Bergmeijer TO,
|
||
Mitchell BD,
|
||
Ritchie MD,
|
||
Déry JP,
|
||
Pakyz RE,
|
||
Gong L,
|
||
Ryan K,
|
||
Kim EY,
|
||
Aradi D,
|
||
Fernandez-Cadenas I,
|
||
Lee MTM,
|
||
Whaley RM,
|
||
Montaner J,
|
||
Gensini GF,
|
||
Cleator JH,
|
||
Chang K,
|
||
Holmvang L,
|
||
Hochholzer W,
|
||
Roden DM,
|
||
Winter S,
|
||
Altman RB,
|
||
Alexopoulos D,
|
||
Kim HS,
|
||
Gawaz M,
|
||
Bliden KP,
|
||
Valgimigli M,
|
||
Marcucci R,
|
||
Campo G,
|
||
Schaeffeler E,
|
||
Dridi NP,
|
||
Wen MS,
|
||
Shin JG,
|
||
Fontana P,
|
||
Giusti B,
|
||
Geisler T,
|
||
Kubo M,
|
||
Trenk D,
|
||
Siller-Matula JM,
|
||
Ten Berg JM,
|
||
Gurbel PA,
|
||
Schwab M,
|
||
Klein TE,
|
||
Shuldiner AR;
|
||
ICPC Investigators</span><br />
|
||
<span class="medgenPMjournal">Eur Heart J Cardiovasc Pharmacother</span>
|
||
2020 Jul 1;6(4):203-210.
|
||
doi: 10.1093/ehjcvp/pvz045.
|
||
<span class="bold">PMID: </span><a href="/pubmed/31504375" target="_blank">31504375</a><a href="/pmc/articles/PMC7363022" target="_blank" class="PubMedFree">Free PMC Article</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/30020015">Beta-1,4-galactosyltransferase 2 c.909C>T gene variant is predictive of on-clopidogrel platelet reactivity.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Pallet N,
|
||
Belleville-Rolland T,
|
||
Savalle A,
|
||
Lejeune M,
|
||
Mauge L,
|
||
Bertil S,
|
||
Loriot MA,
|
||
Gaussem P</span><br />
|
||
<span class="medgenPMjournal">Pharmacogenomics</span>
|
||
2018 Aug 1;19(12):937-945.
|
||
Epub 2018 Jul 18
|
||
doi: 10.2217/pgs-2018-0057.
|
||
<span class="bold">PMID: </span><a href="/pubmed/30020015" target="_blank">30020015</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/23588781">Monitoring aspirin and clopidogrel response: testing controversies and recommendations.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Karathanos A,
|
||
Geisler T</span><br />
|
||
<span class="medgenPMjournal">Mol Diagn Ther</span>
|
||
2013 Jun;17(3):123-37.
|
||
doi: 10.1007/s40291-013-0022-y.
|
||
<span class="bold">PMID: </span><a href="/pubmed/23588781" target="_blank">23588781</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/23275598">Clopidogrel hyper-response and bleeding risk in neurointerventional procedures.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Goh C,
|
||
Churilov L,
|
||
Mitchell P,
|
||
Dowling R,
|
||
Yan B</span><br />
|
||
<span class="medgenPMjournal">AJNR Am J Neuroradiol</span>
|
||
2013 Apr;34(4):721-6.
|
||
Epub 2012 Dec 28
|
||
doi: 10.3174/ajnr.A3418.
|
||
<span class="bold">PMID: </span><a href="/pubmed/23275598" target="_blank">23275598</a><a href="/pmc/articles/PMC7964475" target="_blank" class="PubMedFree">Free PMC Article</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/18804738">Point-of-care measurement of clopidogrel responsiveness predicts clinical outcome in patients undergoing percutaneous coronary intervention results of the ARMYDA-PRO (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty-Platelet Reactivity Predicts Outcome) study.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Patti G,
|
||
Nusca A,
|
||
Mangiacapra F,
|
||
Gatto L,
|
||
D'Ambrosio A,
|
||
Di Sciascio G</span><br />
|
||
<span class="medgenPMjournal">J Am Coll Cardiol</span>
|
||
2008 Sep 30;52(14):1128-33.
|
||
doi: 10.1016/j.jacc.2008.06.038.
|
||
<span class="bold">PMID: </span><a href="/pubmed/18804738" target="_blank">18804738</a></div>
|
||
<div><a target="_blank" href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Clopidogrel%20response%22%20AND%20Diagnosis%2Fbroad%5Bfilter%5D%20%20AND%20%22english%20and%20humans%22%5Bfilter%5D%20NOT%20comment%5BPTYP%5D%20NOT%20letter%5BPTYP%5D" title="PubMed search">See all (53)</a></div><h3 class="subhead">Therapy</h3>
|
||
<div class="nl"><a target="_blank" href="/pubmed/33953382">Pharmacogenetics to guide cardiovascular drug therapy.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Duarte JD,
|
||
Cavallari LH</span><br />
|
||
<span class="medgenPMjournal">Nat Rev Cardiol</span>
|
||
2021 Sep;18(9):649-665.
|
||
Epub 2021 May 5
|
||
doi: 10.1038/s41569-021-00549-w.
|
||
<span class="bold">PMID: </span><a href="/pubmed/33953382" target="_blank">33953382</a><a href="/pmc/articles/PMC8364496" target="_blank" class="PubMedFree">Free PMC Article</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/32732514">Clopidogrel response in patients receiving the nonvitamin K antagonist oral anticoagulants apixaban and rivaroxaban.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Gosetti R,
|
||
Sarafoff N,
|
||
Laugwitz KL,
|
||
Kastrati A,
|
||
Bernlochner I,
|
||
Goedel A</span><br />
|
||
<span class="medgenPMjournal">Coron Artery Dis</span>
|
||
2021 Mar 1;32(2):167-169.
|
||
doi: 10.1097/MCA.0000000000000933.
|
||
<span class="bold">PMID: </span><a href="/pubmed/32732514" target="_blank">32732514</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/30998396">Clopidogrel Pharmacogenetics.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Pereira NL,
|
||
Rihal CS,
|
||
So DYF,
|
||
Rosenberg Y,
|
||
Lennon RJ,
|
||
Mathew V,
|
||
Goodman SG,
|
||
Weinshilboum RM,
|
||
Wang L,
|
||
Baudhuin LM,
|
||
Lerman A,
|
||
Hasan A,
|
||
Iturriaga E,
|
||
Fu YP,
|
||
Geller N,
|
||
Bailey K,
|
||
Farkouh ME</span><br />
|
||
<span class="medgenPMjournal">Circ Cardiovasc Interv</span>
|
||
2019 Apr;12(4):e007811.
|
||
doi: 10.1161/CIRCINTERVENTIONS.119.007811.
|
||
<span class="bold">PMID: </span><a href="/pubmed/30998396" target="_blank">30998396</a><a href="/pmc/articles/PMC6581205" target="_blank" class="PubMedFree">Free PMC Article</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/22624428">Advantages and limitations of clopidogrel response testing methods.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Djukanović N,
|
||
Todorović Z,
|
||
Njegomirović S,
|
||
Ostojić M,
|
||
Prostran M</span><br />
|
||
<span class="medgenPMjournal">Vojnosanit Pregl</span>
|
||
2012 Apr;69(4):353-7.
|
||
<span class="bold">PMID: </span><a href="/pubmed/22624428" target="_blank">22624428</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/19572061">Clopidogrel response variability: current status and future directions.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Ferreiro JL,
|
||
Angiolillo DJ</span><br />
|
||
<span class="medgenPMjournal">Thromb Haemost</span>
|
||
2009 Jul;102(1):7-14.
|
||
doi: 10.1160/TH09-03-0185.
|
||
<span class="bold">PMID: </span><a href="/pubmed/19572061" target="_blank">19572061</a></div>
|
||
<div><a target="_blank" href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Clopidogrel%20response%22%20AND%20Therapy%2Fbroad%5Bfilter%5D%20%20AND%20%22english%20and%20humans%22%5Bfilter%5D%20NOT%20comment%5BPTYP%5D%20NOT%20letter%5BPTYP%5D" title="PubMed search">See all (252)</a></div><h3 class="subhead">Prognosis</h3>
|
||
<div class="nl"><a target="_blank" href="/pubmed/33953382">Pharmacogenetics to guide cardiovascular drug therapy.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Duarte JD,
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Cavallari LH</span><br />
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<span class="medgenPMjournal">Nat Rev Cardiol</span>
|
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2021 Sep;18(9):649-665.
|
||
Epub 2021 May 5
|
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doi: 10.1038/s41569-021-00549-w.
|
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<span class="bold">PMID: </span><a href="/pubmed/33953382" target="_blank">33953382</a><a href="/pmc/articles/PMC8364496" target="_blank" class="PubMedFree">Free PMC Article</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/30020015">Beta-1,4-galactosyltransferase 2 c.909C>T gene variant is predictive of on-clopidogrel platelet reactivity.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Pallet N,
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Belleville-Rolland T,
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Savalle A,
|
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Lejeune M,
|
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Mauge L,
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Bertil S,
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Loriot MA,
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Gaussem P</span><br />
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<span class="medgenPMjournal">Pharmacogenomics</span>
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2018 Aug 1;19(12):937-945.
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Epub 2018 Jul 18
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doi: 10.2217/pgs-2018-0057.
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<span class="bold">PMID: </span><a href="/pubmed/30020015" target="_blank">30020015</a></div>
|
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|
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<div class="nl"><a target="_blank" href="/pubmed/23588781">Monitoring aspirin and clopidogrel response: testing controversies and recommendations.</a></div>
|
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<div class="portlet_content ln"><span class="medgenPMauthor">Karathanos A,
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Geisler T</span><br />
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<span class="medgenPMjournal">Mol Diagn Ther</span>
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2013 Jun;17(3):123-37.
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<span class="bold">PMID: </span><a href="/pubmed/23588781" target="_blank">23588781</a></div>
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<div class="nl"><a target="_blank" href="/pubmed/20965214">Individual variability in the disposition of and response to clopidogrel: pharmacogenomics and beyond.</a></div>
|
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<div class="portlet_content ln"><span class="medgenPMauthor">Xie HG,
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Zou JJ,
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Hu ZY,
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Zhang JJ,
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Ye F,
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Chen SL</span><br />
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2011 Mar;129(3):267-89.
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<span class="bold">PMID: </span><a href="/pubmed/20965214" target="_blank">20965214</a></div>
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<div class="nl"><a target="_blank" href="/pubmed/18941611">Aspirin and clopidogrel response variability: review of the published literature.</a></div>
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<div class="portlet_content ln"><span class="medgenPMauthor">Ferguson AD,
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Dokainish H,
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Lakkis N</span><br />
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<span class="bold">PMID: </span><a href="/pubmed/18941611" target="_blank">18941611</a><a href="/pmc/articles/PMC2565550" target="_blank" class="PubMedFree">Free PMC Article</a></div>
|
||
<div><a target="_blank" href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Clopidogrel%20response%22%20AND%20Prognosis%2Fbroad%5Bfilter%5D%20%20AND%20%22english%20and%20humans%22%5Bfilter%5D%20NOT%20comment%5BPTYP%5D%20NOT%20letter%5BPTYP%5D" title="PubMed search">See all (110)</a></div><h3 class="subhead">Clinical prediction guides</h3>
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<div class="nl"><a target="_blank" href="/pubmed/38597172">P2Y(12) Inhibition in Patients Requiring Oral Anticoagulation After Percutaneous Coronary Intervention: The SWAP-AC-2 Study.</a></div>
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<div class="portlet_content ln"><span class="medgenPMauthor">Ortega-Paz L,
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Bor W,
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Franchi F,
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van den Broek WWA,
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Rollini F,
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Giordano S,
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Galli M,
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Been L,
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Ghanem G,
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Shalhoub A,
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Garabedian H,
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Al Saleh T,
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Uzunoglu E,
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Zhou X,
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Rivas A,
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Pineda AM,
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Suryadevara S,
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Soffer D,
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Mahowald MK,
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Choi CY,
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Zenni MM,
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Phoenix F,
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Ajjan RA,
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Ten Berg JM,
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Angiolillo DJ</span><br />
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2024 Jun 10;17(11):1356-1370.
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|
||
<span class="bold">PMID: </span><a href="/pubmed/38597172" target="_blank">38597172</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/33953382">Pharmacogenetics to guide cardiovascular drug therapy.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Duarte JD,
|
||
Cavallari LH</span><br />
|
||
<span class="medgenPMjournal">Nat Rev Cardiol</span>
|
||
2021 Sep;18(9):649-665.
|
||
Epub 2021 May 5
|
||
doi: 10.1038/s41569-021-00549-w.
|
||
<span class="bold">PMID: </span><a href="/pubmed/33953382" target="_blank">33953382</a><a href="/pmc/articles/PMC8364496" target="_blank" class="PubMedFree">Free PMC Article</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/30020015">Beta-1,4-galactosyltransferase 2 c.909C>T gene variant is predictive of on-clopidogrel platelet reactivity.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Pallet N,
|
||
Belleville-Rolland T,
|
||
Savalle A,
|
||
Lejeune M,
|
||
Mauge L,
|
||
Bertil S,
|
||
Loriot MA,
|
||
Gaussem P</span><br />
|
||
<span class="medgenPMjournal">Pharmacogenomics</span>
|
||
2018 Aug 1;19(12):937-945.
|
||
Epub 2018 Jul 18
|
||
doi: 10.2217/pgs-2018-0057.
|
||
<span class="bold">PMID: </span><a href="/pubmed/30020015" target="_blank">30020015</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/23588781">Monitoring aspirin and clopidogrel response: testing controversies and recommendations.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Karathanos A,
|
||
Geisler T</span><br />
|
||
<span class="medgenPMjournal">Mol Diagn Ther</span>
|
||
2013 Jun;17(3):123-37.
|
||
doi: 10.1007/s40291-013-0022-y.
|
||
<span class="bold">PMID: </span><a href="/pubmed/23588781" target="_blank">23588781</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/20965214">Individual variability in the disposition of and response to clopidogrel: pharmacogenomics and beyond.</a></div>
|
||
<div class="portlet_content ln"><span class="medgenPMauthor">Xie HG,
|
||
Zou JJ,
|
||
Hu ZY,
|
||
Zhang JJ,
|
||
Ye F,
|
||
Chen SL</span><br />
|
||
<span class="medgenPMjournal">Pharmacol Ther</span>
|
||
2011 Mar;129(3):267-89.
|
||
Epub 2010 Oct 19
|
||
doi: 10.1016/j.pharmthera.2010.10.001.
|
||
<span class="bold">PMID: </span><a href="/pubmed/20965214" target="_blank">20965214</a></div>
|
||
<div><a target="_blank" href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Clopidogrel%20response%22%20AND%20Clinical%20prediction%20guides%2Fbroad%5Bfilter%5D%20%20AND%20%22english%20and%20humans%22%5Bfilter%5D%20NOT%20comment%5BPTYP%5D%20NOT%20letter%5BPTYP%5D" title="PubMed search">See all (134)</a></div></div>
|
||
</div>
|
||
|
||
<div class="portlet mgSection" id="ID_104">
|
||
<div class="portlet_head mgSectionHead ui-widget-header"><h1 class="nl" id="Recent_systematic_reviews">Recent systematic reviews</h1><a sid="104" href="#" class="portlet_shutter" title="Show/hide content"></a></div>
|
||
<div class="portlet_content ln">
|
||
<div class="nl"><a target="_blank" href="/pubmed/37963685">Role of genetic polymorphisms in clopidogrel response variability: a systematic review.</a></div>
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<div class="portlet_content ln"><span class="medgenPMauthor">Lopez J,
|
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Mark J,
|
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Duarte GJ,
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Shaban M,
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Sosa F,
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Mishra R,
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Jain S,
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Tran A,
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Khizar A,
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Karpel D,
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Acosta G,
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Rodriguez-Guerra M</span><br />
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<span class="medgenPMjournal">Open Heart</span>
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2023 Nov;10(2)
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doi: 10.1136/openhrt-2023-002436.
|
||
<span class="bold">PMID: </span><a href="/pubmed/37963685" target="_blank">37963685</a><a href="/pmc/articles/PMC10649851" target="_blank" class="PubMedFree">Free PMC Article</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/33578533">Ethnic variance on long term clinical outcomes of concomitant use of proton pump inhibitors and clopidogrel in patients with stent implantation: A PRISMA-complaint systematic review with meta-analysis.</a></div>
|
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<div class="portlet_content ln"><span class="medgenPMauthor">Shi W,
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Yan L,
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Yang J,
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Yu M</span><br />
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<span class="medgenPMjournal">Medicine (Baltimore)</span>
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2021 Feb 12;100(6):e24366.
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doi: 10.1097/MD.0000000000024366.
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<span class="bold">PMID: </span><a href="/pubmed/33578533" target="_blank">33578533</a><a href="/pmc/articles/PMC7886473" target="_blank" class="PubMedFree">Free PMC Article</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/31512486">The Effect of CYP2C19 and Nongenetic Factors on Clopidogrel Responsiveness in the MENA Region: A Systematic Review.</a></div>
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<div class="portlet_content ln"><span class="medgenPMauthor">Ali Z,
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Elewa H</span><br />
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<span class="medgenPMjournal">Clin Appl Thromb Hemost</span>
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2019 Jan-Dec;25:1076029619875520.
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doi: 10.1177/1076029619875520.
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<span class="bold">PMID: </span><a href="/pubmed/31512486" target="_blank">31512486</a><a href="/pmc/articles/PMC6829969" target="_blank" class="PubMedFree">Free PMC Article</a></div>
|
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|
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<div class="nl"><a target="_blank" href="/pubmed/29257922">CYP2C19 genotype and adverse cardiovascular outcomes after stent implantation in clopidogrel-treated Asian populations: A systematic review and meta-analysis.</a></div>
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<div class="portlet_content ln"><span class="medgenPMauthor">Xi Z,
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Fang F,
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Wang J,
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AlHelal J,
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Zhou Y,
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Liu W</span><br />
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<span class="medgenPMjournal">Platelets</span>
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2019;30(2):229-240.
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Epub 2017 Dec 19
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doi: 10.1080/09537104.2017.1413178.
|
||
<span class="bold">PMID: </span><a href="/pubmed/29257922" target="_blank">29257922</a></div>
|
||
|
||
<div class="nl"><a target="_blank" href="/pubmed/22203539">CYP2C19 genotype, clopidogrel metabolism, platelet function, and cardiovascular events: a systematic review and meta-analysis.</a></div>
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<div class="portlet_content ln"><span class="medgenPMauthor">Holmes MV,
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Perel P,
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Shah T,
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Hingorani AD,
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Casas JP</span><br />
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<span class="medgenPMjournal">JAMA</span>
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2011 Dec 28;306(24):2704-14.
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<span class="bold">PMID: </span><a href="/pubmed/22203539" target="_blank">22203539</a></div>
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<div><a target="_blank" href="https://pubmed.ncbi.nlm.nih.gov/?term=%22Clopidogrel%20response%22%20AND%20systematic%5Bsb%5D%20AND%20%22english%20and%20humans%22%5Bfilter%5D%20NOT%20comment%5BPTYP%5D%20NOT%20letter%5BPTYP%5D" title="PubMed search">See all (6)</a></div></div>
|
||
</div>
|
||
|
||
<div class="portlet mgSection" id="ID_120">
|
||
<div class="portlet_head mgSectionHead ui-widget-header"><h1 class="nl" id="Therapeutic_recommendations">Therapeutic recommendations</h1><a sid="120" href="#" class="portlet_shutter" title="Show/hide content"></a></div>
|
||
<div class="portlet_content ln" id="therapeutic"><strong>From <a href="https://www.ncbi.nlm.nih.gov/books/NBK84114" target="_blank">Medical Genetics Summaries</a></strong><br /><div id="TheraputicContent"><div class="divPopper rprt" id="clopidogrel_REF_1" style="display: none;">1. CLOPIDOGREL BISULFATE- clopidogrel bisulfate tablet. Torrent Pharmaceuticals Limited; 2022. Available from: <a href="https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ae07b785-b522-41c6-b27c-24c4d5cd814d" target="_blank">https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ae07b785-b522-41c6-b27c-24c4d5cd814d</a></div><div class="divPopper rprt" id="clopidogrel_REF_3" style="display: none;">3. Lee C.R., Luzum J.A., Sangkuhl K., Gammal R.S., et al. Clinical Pharmacogenetics Implementation Consortium Guideline for CYP2C19 Genotype and Clopidogrel Therapy: 2022 Update. Clin Pharmacol Ther. 2022.</div><div class="divPopper rprt" id="clopidogrel_REF_4" style="display: none;">4. Royal Dutch Pharmacists Association (KNMP). Dutch Pharmacogenetics Working Group (DPWG). Pharmacogenetic Guidelines [Internet]. Netherlands. Clopidogrel – CYP2C19 [Cited 1 Feb 2022]. Available from: <a href="https://www.knmp.nl/dossiers/farmacogenetica" target="_blank">https://www.knmp.nl/dossiers/farmacogenetica</a></div><p><b>This section contains excerpted</b>
|
||
<sup>1</sup>
|
||
<b>information on gene-based dosing recommendations. Neither this section nor other parts of this review contain the complete recommendations from the sources.</b>
|
||
</p><h2>2022 Statement from the US Food and Drug Administration (FDA)</h2><p>WARNING: DIMINISHED ANTIPLATELET EFFECT IN PATIENTS WITH TWO LOSS-OF-FUNCTION ALLELES OF THE CYP2C19 GENE</p><p>The effectiveness of clopidogrel bisulfate results from its antiplatelet activity, which is dependent on its conversion to an active metabolite by the cytochrome P450 (CYP) system, principally CYP2C19 … Clopidogrel bisulfate at recommended doses forms less of the active metabolite and so has a reduced effect on platelet activity in patients who are homozygous for nonfunctional alleles of the CYP2C19 gene, (termed "CYP2C19 poor metabolizers"). Tests are available to identify patients who are CYP2C19 poor metabolizers … Consider use of another platelet P2Y12 inhibitor in patients identified as CYP2C19 poor metabolizers.</p><p>[…]</p><p>Clopidogrel is a prodrug. Inhibition of platelet aggregation by clopidogrel is achieved through an active metabolite. The metabolism of clopidogrel to its active metabolite can be impaired by genetic variations in CYP2C19 … The metabolism of clopidogrel can also be impaired by drugs that inhibit CYP2C19, such as omeprazole or esomeprazole. Avoid concomitant use of clopidogrel bisulfate with omeprazole or esomeprazole because both significantly reduce the antiplatelet activity of clopidogrel bisulfate.</p><p>[…]</p><p>Rifampin strongly induces CYP2C19 resulting to both an increase level of clopidogrel active metabolite and platelet inhibition, which in particular might potentiate the risk of bleeding. As a precaution, avoid concomitant use of strong CYP2C19 inducers. […]</p><p>Clopidogrel is metabolized to its active metabolite in part by CYP2C19. Concomitant use of drugs that inhibit the activity of this enzyme results in reduced plasma concentrations of the active metabolite of clopidogrel and a reduction in platelet inhibition… Avoid concomitant use of clopidogrel bisulfate with omeprazole or esomeprazole.</p><p>[…]</p><p>CYP2C19 is involved in the formation of both the active metabolite and the 2-oxoclopidogrel intermediate metabolite. Clopidogrel active metabolite pharmacokinetics and antiplatelet effects, as measured by ex vivo platelet aggregation assays, differ according to CYP2C19 genotype. Patients who are homozygous for nonfunctional alleles of the CYP2C19 gene are termed "CYP2C19 poor metabolizers." Approximately 2% of White and 4% of Black patients are poor metabolizers; the prevalence of poor metabolism is higher in Asian patients (e.g., 14% of Chinese). Tests are available to identify patients who are CYP2C19 poor metabolizers.</p><p><b>Please review the complete therapeutic recommendations that are located here: (</b>
|
||
<b>1</b>
|
||
<b>)</b>
|
||
.</p><h2>2022 Statement from the Clinical Pharmacogenetics Implementation Consortium (CPIC)</h2><p>In patients with ACS and/or undergoing PCI…avoid clopidogrel in CYP2C19 Ims and PMs and use an alternative antiplatelet agent, such as prasugrel or ticagrelor, if no contraindications.</p><p>[…]</p><p>If considering clopidogrel and the patient is a CYP2C19 NM, the standard dose (75 mg/day) is recommended. Although clopidogrel-treated CYP2C19 RMs and Ums may experience lower on-treatment platelet reactivity compared with NMs, clinical data also support the use of clopidogrel at standard doses in CYP2C19 RMs and Ums due to the lack of evidence demonstrating significant differences in risk of bleeding or ischemic events compared with NMs in patients undergoing PCI.</p><p>[…]</p><p>There remain limited data regarding the potential benefit of CYP2C19-guided antiplatelet therapy on outcomes exclusively in patients undergoing PCI for a non-ACS indication. Patients undergoing elective PCI have a lower risk of cardiovascular events compared with patients with ACS, but were included in multiple studies evaluating outcomes of genotype-guided antiplatelet therapy, including the IGNITE and TAILOR-PCI studies (Table S2). Therefore, the therapeutic recommendations for patients with ACS and/or undergoing PCI may also be considered for patients undergoing elective PCI.</p><p>[…]</p><p>In patients with a cardiovascular indication for clopidogrel outside the setting of an ACS or PCI, including the treatment of patients with peripheral arterial disease or stable coronary artery disease following a recent MI, the standard dose (75 mg/day) is recommended if the patient is a CYP2C19 NM. However, there are insufficient data to make a clinical recommendation for CYP2C19 Ums, RMs, and Ims. If the patient is a CYP2C19 PM, it is recommended to avoid clopidogrel and use prasugrel or ticagrelor at standard doses if no contraindication.</p><p>[…]</p><p>If considering clopidogrel for patients with neurovascular disease, including the treatment of acute ischemic stroke or TIA, the secondary prevention of stroke, or the prevention of thromboembolic events following neurointerventional procedures, such as carotid artery stenting and endarterectomy and stent-assisted coiling of intracranial aneurysms, the standard dose (75 mg/day) is recommended in CYP2C19 NMs (Table 3). In CYP2C19 Ims and PMs, there is a “moderate” recommendation to avoid clopidogrel if possible and consider an alternative P2Y12 inhibitor at standard doses if clinically indicated and no contraindication. Alternative P2Y12 inhibitors not impacted by <i>CYP2C19</i> genetic variants with indications for patients with stroke include ticagrelor and ticlopidine. However, ticlopidine has serious hematological adverse effects that also need to be considered. Prasugrel is contraindicated in patients with a history of stroke or TIA.</p><p><b>Please review the complete therapeutic recommendations that are located here:</b>
|
||
(<a title="click for more information" class="jig-ncbipopper s_TOP" href="#clopidogrel_REF_3" data-jigconfig="hasArrow: true, openEvent: 'click', closeEvent: 'mouseout', openAnimation: 'fadeIn', closeAnimation: 'fadeOut', triggerPosition: 'center right', destPosition: 'center left', arrowDirection: 'left'">3</a>)</p><h2>2019 Summary of Recommendations from the Dutch Pharmacogenetics Working Group (DPWG) of the Royal Dutch Association for the Advancement of Pharmacy (KNMP)</h2><p>CYP2C19 PM: CLOPIDOGREL</p><p>The risk of serious cardiovascular and cerebrovascular events is increased in patients undergoing balloon angioplasty or stent placement (percutaneous coronary intervention) and in patients with a stroke or TIA, because the genetic variation reduces the activation of clopidogrel. No negative clinical consequences have been proved in other patients.</p><ul><li>PERCUTANEOUS CORONARY INTERVENTION, STROKE or TIA:<ul><li>avoid clopidogrel</li><li>Prasugrel, ticagrelor and acetylsalicylic acid/dipyridamole are not metabolised by CYP2C19 (or to a lesser extent).</li></ul></li><li>OTHER INDICATIONS:<ul><li>determine the level of inhibition of platelet aggregation by clopidogrel</li><li>consider an alternative in poor responders</li><li>Prasugrel and ticagrelor are not metabolised by CYP2C19 (or to a lesser extent).</li></ul></li></ul><p>CYP2C19 IM: clopidogrel</p><p>The risk of serious cardiovascular and cerebrovascular events is increased in patients undergoing balloon angioplasty or stent placement (percutaneous coronary intervention) and in patients with a stroke or TIA, as the genetic variation reduces the activation of clopidogrel. No negative clinical consequences have been observed in other patients.</p><ul><li>PERCUTANEOUS CORONARY INTERVENTION, STROKE or TIA:<ul><li>choose an alternative or double the dose to 150 mg/day (600 mg loading dose); Prasugrel, ticagrelor and acetylsalicylic acid/dipyridamole are not metabolised by CYP2C19 (or to a lesser extent).</li></ul></li><li>OTHER INDICATIONS:<ul><li>no action required</li></ul></li></ul><p>CYP2C19 UM: clopidogrel</p><p>NO action is required for this gene-drug interaction.</p><p>The genetic variation results in increased conversion of clopidogrel to the active metabolite. However, this can result in both positive effects (reduction in the risk of serious cardiovascular and cerebrovascular events) and negative effects (increase in the risk of bleeding).</p><p><b>Please review the complete therapeutic recommendations that are located here: (</b>
|
||
<b>4</b>
|
||
<b>)</b>
|
||
.</p><table id="clopidogrel.T.the_cpic_2022_antiplatelet_1" frame="hsides" rules="groups"><caption>Table 3. The CPIC (2022) Antiplatelet Therapy Recommendations Based on CYP2C19 Phenotype when Considering Clopidogrel for Neurovascular<sup>a</sup>
|
||
Indications</caption><tfoot><tr><td colspan="4"><sup>a</sup>
|
||
|
||
. Neurovascular disease includes acute ischemic stroke or transient ischemic attack (TIA), secondary prevention of stroke, or prevention of thromboembolic events following neurointerventional procedures, such as carotid artery stenting and stent-assisted coiling of intracranial aneurysms.</td></tr><tr><td colspan="4"><sup>b</sup>
|
||
|
||
. The strength of the recommendation for “likely” phenotypes are the same as their respective confirmed phenotypes; “likely” indicates the uncertainty in phenotype assignment due to limited data for reduced function alleles.</td></tr><tr><td colspan="4"><sup>c</sup>
|
||
|
||
. Alternative P2Y12 inhibitors not impacted by CYP2C19 genetic variants include ticagrelor and ticlopidine. Prasugrel is contraindicated in individuals with a history of stroke or TIA. Given limited outcomes data for genotype-guided antiplatelet therapy for neurovascular indications, selection of therapy should depend on the individual’s treatment goals and risks for adverse events.</td></tr><tr><td colspan="4">Please see Therapeutic Recommendations based on Genotype for more information from CPIC. This table is adapted from (<a title="click for more information" class="jig-ncbipopper s_TOP" href="#clopidogrel_REF_3" data-jigconfig="hasArrow: true, openEvent: 'click', closeEvent: 'mouseout', openAnimation: 'fadeIn', closeAnimation: 'fadeOut', triggerPosition: 'center right', destPosition: 'center left', arrowDirection: 'left'">3</a>). CPIC - Clinical Pharmacogenetics Implementation Consortium</td></tr></tfoot><thead><tr><th id="hd_h_clopidogrel.T.the_cpic_2022_antiplatelet_1_1_1_1_1" valign="top" align="left" scope="col" rowspan="1" colspan="1">CYP2C19 phenotype</th><th id="hd_h_clopidogrel.T.the_cpic_2022_antiplatelet_1_1_1_1_2" valign="top" align="left" scope="col" rowspan="1" colspan="1">Implications for clopidogrel</th><th id="hd_h_clopidogrel.T.the_cpic_2022_antiplatelet_1_1_1_1_3" valign="top" align="left" scope="col" rowspan="1" colspan="1">Therapeutic recommendation</th><th id="hd_h_clopidogrel.T.the_cpic_2022_antiplatelet_1_1_1_1_4" valign="top" align="left" scope="col" rowspan="1" colspan="1">Classification of recommendation<sup>b</sup>
|
||
</th></tr></thead><tbody><tr><td headers="hd_h_clopidogrel.T.the_cpic_2022_antiplatelet_1_1_1_1_1" valign="top" align="left" scope="row" rowspan="1" colspan="1">Ultrarapid metabolizer (UM)</td><td headers="hd_h_clopidogrel.T.the_cpic_2022_antiplatelet_1_1_1_1_2" valign="top" align="left" rowspan="1" colspan="1">Increased clopidogrel active metabolite formation; lower on-treatment platelet reactivity; no association with higher bleeding risk</td><td headers="hd_h_clopidogrel.T.the_cpic_2022_antiplatelet_1_1_1_1_3" rowspan="2" valign="top" align="left" colspan="1">No recommendation</td><td headers="hd_h_clopidogrel.T.the_cpic_2022_antiplatelet_1_1_1_1_4" rowspan="2" valign="top" align="left" colspan="1">No recommendation</td></tr><tr><td headers="hd_h_clopidogrel.T.the_cpic_2022_antiplatelet_1_1_1_1_1" valign="top" align="left" scope="row" rowspan="1" colspan="1">Rapid metabolizer (RM)</td><td headers="hd_h_clopidogrel.T.the_cpic_2022_antiplatelet_1_1_1_1_2" valign="top" align="left" rowspan="1" colspan="1">Normal or increased clopidogrel active metabolite formation; normal or lower on-treatment platelet reactivity; no association with higher bleeding risk</td></tr><tr><td headers="hd_h_clopidogrel.T.the_cpic_2022_antiplatelet_1_1_1_1_1" valign="top" align="left" scope="row" rowspan="1" colspan="1">Normal metabolizer (NM)</td><td headers="hd_h_clopidogrel.T.the_cpic_2022_antiplatelet_1_1_1_1_2" valign="top" align="left" rowspan="1" colspan="1">Normal clopidogrel active metabolite formation; normal on-treatment platelet reactivity</td><td headers="hd_h_clopidogrel.T.the_cpic_2022_antiplatelet_1_1_1_1_3" valign="top" align="left" rowspan="1" colspan="1">If considering clopidogrel, use at standard dose (75 mg/day)</td><td headers="hd_h_clopidogrel.T.the_cpic_2022_antiplatelet_1_1_1_1_4" valign="top" align="left" rowspan="1" colspan="1">Strong</td></tr><tr><td headers="hd_h_clopidogrel.T.the_cpic_2022_antiplatelet_1_1_1_1_1" valign="top" align="left" scope="row" rowspan="1" colspan="1">Likely and confirmed intermediate metabolizer (IM)</td><td headers="hd_h_clopidogrel.T.the_cpic_2022_antiplatelet_1_1_1_1_2" valign="top" align="left" rowspan="1" colspan="1">Reduced clopidogrel active metabolite formation; increased on-treatment platelet reactivity; increased risk for adverse cardiac and cerebrovascular events</td><td headers="hd_h_clopidogrel.T.the_cpic_2022_antiplatelet_1_1_1_1_3" valign="top" align="left" rowspan="1" colspan="1">Consider an alternative<sup>c</sup>
|
||
P2Y12 inhibitor at standard dose if clinically indicated and no contraindication</td><td headers="hd_h_clopidogrel.T.the_cpic_2022_antiplatelet_1_1_1_1_4" valign="top" align="left" rowspan="1" colspan="1">Moderate</td></tr><tr><td headers="hd_h_clopidogrel.T.the_cpic_2022_antiplatelet_1_1_1_1_1" valign="top" align="left" scope="row" rowspan="1" colspan="1">Likely and confirmed poor metabolizer (PM)</td><td headers="hd_h_clopidogrel.T.the_cpic_2022_antiplatelet_1_1_1_1_2" valign="top" align="left" rowspan="1" colspan="1">Significantly reduced clopidogrel active metabolite formation; increased on-treatment platelet reactivity; increased risk for adverse cardiac and cerebrovascular events</td><td headers="hd_h_clopidogrel.T.the_cpic_2022_antiplatelet_1_1_1_1_3" valign="top" align="left" rowspan="1" colspan="1">Avoid clopidogrel if possible.<br />Consider an alternative<sup>c</sup>
|
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P2Y12 inhibitor at standard dose if clinically indicated and no contraindication</td><td headers="hd_h_clopidogrel.T.the_cpic_2022_antiplatelet_1_1_1_1_4" valign="top" align="left" rowspan="1" colspan="1">Moderate</td></tr></tbody></table><p><sup>1</sup>
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||
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||
The FDA labels specific drug formulations. We have substituted the generic names for any drug labels in this excerpt. The FDA may not have labeled all formulations containing the generic drug. Certain terms, genes and genetic variants may be corrected in accordance to nomenclature standards, where necessary. We have given the full name of abbreviations, shown in square brackets, where necessary.</p></div></div>
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<h2 class="offscreen_noflow">Supplemental Content</h2>
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<div class="portlet_head mgSectionHead ui-widget-header"><h1 class="nl" id="Table_of_contents">Table of contents</h1><a sid="113" href="#" class="portlet_shutter" title="Show/hide content"></a></div>
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<div class="portlet_head mgSectionHead ui-widget-header"><h1 class="nl" id="Genetic_Testing_Registry">Genetic Testing Registry</h1><a sid="106" href="#" class="portlet_shutter" title="Show/hide content"></a></div>
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<div class="portlet_content ln"><ul><li><a href="/gtr/tests?term=C2674941%5bDISCUI%5d&filter=method%3A2%5F8" target="_blank">Deletion/duplication analysis (5)</a></li>
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||
<li><a href="/gtr/tests?term=C2674941%5bDISCUI%5d&filter=method%3A2%5F7" target="_blank">Sequence analysis of the entire coding region (1)</a></li>
|
||
<li><a href="/gtr/tests?term=C2674941%5bDISCUI%5d&filter=method%3A2%5F19" target="_blank">Targeted variant analysis (22)</a></li>
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<li class="portletSeeAll portletSeeAllPad"><total><a href="/gtr/tests?term=C2674941%5bDISCUI%5d" target="_blank">See all (23)</a></total></li>
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<div class="portlet_content ln"><ul><li><a href="https://www.pharmgkb.org/chemical/PA449053" target="_blank">PharmGKB</a></li><li><a href="https://clinicaltrials.gov/search?cond=Clopidogrel%20response" target="_blank">ClinicalTrials.gov</a></li></ul></div>
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<div class="portlet_content ln"><ul class="a_poppers"><li><a target="_blank" href="https://pubmed.ncbi.nlm.nih.gov/?term=(%22clopidogrel%22%5Btiab%3A~0%5D)%20AND%20(%22english%20and%20humans%22%5BFilter%5D)%20AND%20(%20(%22practice%20guideline%22%5BFilter%5D)%20OR%20(practice*%5Btitl%5D%20AND%20(guideline%5Btitl%5D%20OR%20parameter%5Btitl%5D%20OR%20resource%5Btitl%5D%20OR%20bulletin%5Btitl%5D%20OR%20best%5Btitl%5D))%20OR%20(genetic*%5Btitl%5D%20AND%20(evaluation%5Btitl%5D%20OR%20counseling%5Btitl%5D%20OR%20screening%5Btitl%5D%20OR%20test*%5Btitl%5D))%20OR%20(clinical%5Btitl%5D%20AND%20((expert%5Btitl%5D%20AND%20consensus%5Btitl%5D)%20OR%20utility%5Btitl%5D%20OR%20guideline*%5Btitl%5D))%20OR%20(management%5Btitl%5D%20AND%20(clinical%5Btitl%5D%20OR%20diagnos*%5Btitl%5D%20OR%20recommendation%5Btitl%5D%20OR%20pain%5Btitl%5D%20OR%20surveillance%5Btitl%5D%20OR%20emergency%5Btitl%5D%20OR%20guideline*%5Btitl%5D%20OR%20therap*))%20OR%20(treatment%5Btitl%5D%20AND%20((evaluation%5Btitl%5D%20AND%20diagnosis%5Btitl%5D)%20OR%20(assessment%5Btitl%5D%20AND%20prevention%5Btitl%5D)%20OR%20therap*))%20OR%20(Diagnos*%5Btitl%5D%20AND%20(prenatal%5Btitl%5D%20OR%20treatment%5Btitl%5D%20OR%20follow-up%5Btitl%5D%20OR%20statement%5Btitl%5D%20OR%20criteria%5Btitl%5D%20OR%20newborn%5Btitl%5D%20OR%20differential%5Btitl%5D%20OR%20neonatal%5Btitl%5D%20OR%20neonate%5Btitl%5D))%20OR%20(guideline*%5Btitl%5D%20AND%20(pharmacogenetic*%5Btitl%5D%20OR%20recommendation%5Btitl%5D%20OR%20therap*%5Btitl%5D%20OR%20evidence-based%5Btitl%5D%20OR%20consensus%5Btitl%5D%20OR%20(technical%5Btitl%5D%20AND%20standard*%5Btitl%5D)%20OR%20(molecular%5Btitl%5D%20AND%20testing%5Btitl%5D)))%20OR%20(risk%5Btitl%5D%20AND%20assessment%5Btitl%5D)%20OR%20(recommendation*%5Btitl%5D%20AND%20(statement%5Btitl%5D%20OR%20Evidence-based%5Btitl%5D%20OR%20Consensus%5Btitl%5D))%20OR%20(care%20AND%20((Patient%5Btitl%5D%20AND%20standard*%5Btitl%5D)%20OR%20primary%5Btitl%5D%20OR%20psychosocial%5Btitl%5D))%20OR%20(Health%5Btitl%5D%20AND%20supervision%5Btitl%5D)%20OR%20(statement%5Btitl%5D%20AND%20(policy%5Btitl%5D%20OR%20position%5Btitl%5D%20OR%20Consensus%5Btitl%5D))%20OR%20(pharmacogenetics%5Btitl%5D%20AND%20(Dosing%5Btitl%5D%20OR%20therap*%5Btitl%5D%20OR%20genotype*%5Btitl%5D%20OR%20drug*%5Btitl%5D))%20OR%20(Chemotherapy%5Btitl%5D%20AND%20decision*%5Btitl%5D)%20OR%20(screening%5Btitl%5D%20AND%20(newborn%5Btitl%5D%20OR%20neonat*%5Btitl%5D%20OR%20detection%5Btitl%5D%20OR%20diagnos*%5Btitl%5D))%20OR%20(criteria%5Btitl%5D%20OR%20genotype*%5Btitl%5D)%20)%20NOT%20(%22Case%20reports%22%5BPublication%20type%5D%20OR%20%22clinical%20study%22%5BPublication%20Type%5D%20OR%20%22randomized%20controlled%20trial%22%5BPublication%20Type%5D)" title="PubMed search">PubMed</a><div class="help-popup">See practice and clinical guidelines in PubMed. The search results may include broader topics and may not capture all published guidelines. See the <a href="/medgen/docs/faq/" title="Frequently asked questions" target="_blank">FAQ</a> for details.</div></li></ul><h3 class="subhead">Curated</h3><ul class="a_poppers"><li><a target="_blank" href="https://www.knmp.nl/media/1058">DPWG, 2023</a><div>Royal Dutch Pharmacists Association (KNMP). Dutch Pharmacogenetics Working Group (DPWG). Pharmacogenetic Recommendation.</div></li></ul></div>
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<div class="portlet_head mgSectionHead ui-widget-header"><h1 class="nl" id="Molecular_resources">Molecular resources</h1><a sid="115" href="#" class="portlet_shutter" title="Show/hide content"></a></div>
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<div class="portlet_content ln"><ul><li><a href="http://www.omim.org/search?index=entry&start=1&limit=10&sort=score%20desc&field=number&search=124020" target="_blank">OMIM</a></li><li><a href="/clinvar/?term=1557[geneid]" target="_blank">View CYP2C19 variations in ClinVar</a></li><li><a href="/nuccore/197116374" target="_blank">RefSeqGene</a></li></ul></div>
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<div class="portlet_content ln"><ul><li><a href="https://vsearch.nlm.nih.gov/vivisimo/cgi-bin/query-meta?v:project=medlineplus&query=Clopidogrel%20response" target="_blank">MedlinePlus</a></li><li><a href="https://medlineplus.gov/genetics/condition/clopidogrel-resistance" target="_blank">MedlinePlusGenetics (GHR)</a></li></ul></div>
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||
<a href="/books/NBK84114" ref="ncbi_uid=&discoId=gtr_reviews&linkpos=1&linkpostotal=3" target="_blank">Medical Genetics Summaries</a>
|
||
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|
||
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||
<a href="/pubmed/clinical?term=Clopidogrel%20response" ref="ncbi_uid=&discoId=gtr_reviews&linkpos=2&linkpostotal=3" target="_blank">PubMed Clinical Queries</a>
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<a href="/pubmed?term=Clopidogrel%20response%20AND%20humans[mesh]%20AND%20review[publication%20type]" ref="ncbi_uid=&discoId=gtr_reviews&linkpos=3&linkpostotal=3" target="_blank">Reviews in PubMed</a>
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<h3>Related information</h3>
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||
<a class="brieflinkpopperctrl" href="/clinvar?LinkName=medgen_clinvar&from_uid=382487" ref="log$=recordlinks">ClinVar</a>
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<div class="brieflinkpop offscreen_noflow">Related medical variations</div>
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<a class="brieflinkpopperctrl" href="/gene?LinkName=medgen_gene_diseases&from_uid=382487" ref="log$=recordlinks">Gene</a>
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<a class="brieflinkpopperctrl" href="/gtr/tests?term=C2674941[DISCUI]" ref="log$=recordlinks">GTR</a>
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<div class="brieflinkpop offscreen_noflow">Clinical tests in GTR</div>
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<a class="brieflinkpopperctrl" href="/books?LinkName=medgen_books&from_uid=382487" ref="log$=recordlinks">NCBI Bookshelf</a>
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<div class="brieflinkpop offscreen_noflow">Related information in NCBI Bookshelf</div>
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|
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<div class="brieflinkpop offscreen_noflow">OMIM records containing genes associated with phenotypes registered in MedGen</div>
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<a class="brieflinkpopperctrl" href="/pmc?LinkName=medgen_pmc&from_uid=382487" ref="log$=recordlinks">PMC Articles</a>
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<a class="brieflinkpopperctrl" href="/pubmed?LinkName=medgen_pubmed&from_uid=382487" ref="log$=recordlinks">PubMed</a>
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<div class="brieflinkpop offscreen_noflow">Related literature resources in PubMed</div>
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<div class="brieflinkpop offscreen_noflow">Links to PubMed based on citations in GeneReviews and Medical Genetics Summaries</div>
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||
<li class="brieflinkpopper">
|
||
<a class="brieflinkpopperctrl" href="/pubmed?LinkName=medgen_pubmed_omim&from_uid=382487" ref="log$=recordlinks">PubMed (OMIM)</a>
|
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<div class="brieflinkpop offscreen_noflow">Related literature resources in PubMed</div>
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|
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<a class="htb ralinkpopperctrl" ref="log$=activity&linkpos=1" href="/portal/utils/pageresolver.fcgi?recordid=67cd1caba68b6b5afc79725f">Clopidogrel response</a>
|
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<div class="ralinkpop offscreen_noflow">Clopidogrel response<div class="brieflinkpopdesc"></div></div>
|
||
<div class="tertiary">MedGen</div>
|
||
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