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Cardiovascular clinical pharmaceutical research
Randomised comparison of adjunctive naoxintong versus standard maintenance dose clopidogrel in patients with CYP2C19*2 gene mutation
  1. Hui Chen
  1. Fujian Provincial Hospital, Fujian, China

Abstract

Objectives The purpose of this study was to determine the impact of adjunctive Buchang Naoxintong Jiaonang (BNJ) in patients with CYP2C19*2 gene mutation undergoing percutaneous coronary intervention (PCI).

Background Although adjunctive BNJ to clopidogrel can enhance the antiplatelet effect in volunteers with CYP2C19*2 gene mutation, it is unknown whether adjunctive BNJ can improve the clinical prognosis in patients with CYP2C19*2 gene mutation undergoing PCI.

Methods 90 patients with CYP2C19*2 gene mutation after a 300-mg loading dose of clopidogrel were enrolled. CYP2C19*2 gene mutation was confirmed by TaqMan PCR. Patients were randomly assigned to receive either adjunctive BNJ (trial group; n=45) or standard maintenance dose clopidogrel (control group; n=45). Platelet function was assessed at baseline and after 7 days with conventional aggregometry. Subsequent major adverse cardiovascular events (MACE, including cardiac death and acute coronary syndrome) were recorded during a median follow-up of 9 months.

Results Baseline platelet function measurements were similar in both groups. After 7 days, Percent inhibitions of 5 µmol/l ADP-induced maximum platelet aggregation and late platelet aggregation were significantly greater in the trial versus control group (42.3±16.0% vs 20.8±15.2%, p<0.001, and 54.7±18.3% vs 21.5±29.2%, p<0.001, respectively). During a follow-up for median 9 months, subsequent MACE (6/45) in trial group were much lower than those (14/45) in control group (p<0.05).

Conclusion Adjunctive BNJ to standard maintenance dose clopidogrel can enhance the antiplatelet effect and decrease subsequent MACE in patients who carried CYP2C19*2 gene mutation undergoing PCI.

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