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Journal Publication
Title of Article Interaction of CYP2C19 G681A polymorphism and omeprazole on clopidogrel responsiveness and impact in patients with acute coronary syndrome 
Date of Acceptance 8 September 2019 
Journal
     Title of Journal Coronary Artery Disease 
     Standard ISI 
     Institute of Journal Lippincott Williams & Wilkins Ltd. 
     ISBN/ISSN 0954-6928 
     Volume  
     Issue  
     Month
     Year of Publication 2019 
     Page  
     Abstract Objective: To explore the individual effects of the CYP2C19 G681A polymorphism and omeprazole use and their interaction on clopidogrel responsiveness in acute coronary syndrome (ACS) patients. Background: The CYP2C19 G681A polymorphism and omeprazole use were both known for retarding the effects of clopidogrel under broad cardiovascular conditions; however, data from ACS patients was limited. Methods: We conducted a cross-sectional study of 102 ACS patients who received clopidogrel prior to percutaneous coronary intervention. The platelet function was assessed by a Platelet Function Analyzer-200, in which clopidogrel hyporesponsiveness was defined as a closure time (CT) of ≤106 seconds. The CYP2C19 G681A polymorphism was investigated using the PCR-RFLP technique. Statistical analysis was performed by Chi-square test, Student’s t-test, binary logistic regression, and receiver-operating characteristic (ROC) curve. Results: Carriages of the CYP2C19 681A allele and omeprazole use were present in 48 (47.1%) and 38 (37.3%) patients, respectively. The mean CT±SD was 103.1±1.7 seconds and the prevalence of clopidogrel hyporesponsiveness was 66.7%. The CT was significantly shorter in carriages of the 681A allele compared with the 681G allele (87.1±1.5 vs. 119.9±1.8, P = 0.002), but had no significant difference in patients with vs. without omeprazole use (97.8±1.8 vs. 106.3±1.4, P = 0.467). The ROC analysis of an effect on clopidogrel hyporesponsiveness of CYP2C19 G681A alone and combination between CYP2C19 G681A and omeprazole use had AUC (95% CI) values of 0.654 (0.543 to 0.766), P = 0.011, and 0.672 (0.564 to 0.779), P = 0.005, respectively. Conclusions: In ACS patients, the effect of the CYP2C19 G681A polymorphism on clopidogrel responsiveness, but not omeprazole use, is strong. However, a combination of both factors enhances clopidogrel hyporesponsiveness.  
     Keyword acute coronary syndrome, clopidogrel, CYP2C19, omeprazole, polymorphism 
Author
557100009-4 Mr. SORNSITH JIRUNGDA [Main Author]
Graduate School Doctoral Degree

Reviewing Status มีผู้ประเมินอิสระ 
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Level of Publication นานาชาติ 
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