A prospective randomized evaluation of a pharmacogenomic approach to antiplatelet therapy among @entity1 with XXXX : the RAPID @entity583 study.

@entity1 @entity1262 @entity63 @entity4433 @entity1423 @entity583 @entity3075
UNASSIGNED: Treatment of carriers of the @entity4433 *2 allele and @entity1262 TT genotype with clopidogrel is associated with @entity63 after percutaneous coronary intervention (PCI). We sought to evaluate a pharmacogenomic strategy among @entity1 undergoing PCI for @entity583 ( @entity583 ), by performing a randomized trial, enrolling 102 @entity1 . Point-of-care genetic testing for @entity4433 *2, @entity1262 TT and @entity4433 *17 was performed with carriers of either the @entity4433 *2 allele or @entity1262 TT genotype randomly assigned to a strategy of prasugrel 10   mg daily or an augmented dosing strategy of clopidogrel (150   mg daily for 6 days then 75   mg daily). The primary end point was the proportion of at-risk carriers exhibiting @entity1423 ( @entity1423 ), a marker associated with increased adverse cardiovascular events, after 1 month. Fifty-nine subjects (57.8%) were identified as carriers of at least one at-risk variant. Treatment with prasugrel significantly reduced @entity1423 compared with clopidogrel by @entity3075 reaction unit (PRU) thresholds of >234 (0 vs 24.1%, P=0.0046) and PRU>208 (3.3 vs 34.5%, P=0.0025). The sensitivity of point-of-care testing was 100% (95% CI 88.0-100), 100% (86.3-100) and 96.9% (82.0-99.8) and specificity was 97.0% (88.5-99.5), 97.1% (89.0-99.5) and 98.5% (90.9-99.9) for identifying @entity4433 *2, @entity1262 TT and @entity4433 *17, respectively. Logistic regression confirmed carriers as a strong predictor of @entity1423 (OR=6.58, 95% CI 1.24-34.92; P=0.03). We confirmed that concurrent identification of three separate genetic variants in @entity1 with @entity583 receiving PCI is feasible at the bedside. Among carriers of at-risk genotypes, treatment with prasugrel was superior to an augmented dosing strategy of clopidogrel in reducing @entity1423 .The Pharmacogenomics Journal advance online publication, 7 April 2015; doi:10.1038/tpj.2015.17.
