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Efficacy of CYP2C19 genotype-guided clopidogrel therapy in coronary heart disease

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Created On: 29/04/2026

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Key take away

Genotype-guided antiplatelet therapy using CYP2C19 testing improves outcomes and reduces cardiovascular events in coronary heart disease without increasing bleeding risk.

Background

Coronary atherosclerotic heart disease, commonly known as coronary heart disease, arises primarily from reduced coronary blood flow, leading to myocardial hypoxia and ischemia, which manifest as chest pain and related complications. In acute coronary syndrome, antiplatelet therapy plays a fundamental role in thrombotic events prevention.

Clopidogrel, a second-generation antiplatelet agent, is widely used. However, its potency varies based on genetic factors. Pre-treatment genetic testing may help optimize therapeutic outcomes. While most studies focus on patients undergoing percutaneous coronary intervention, limited evidence exists for those managed without PCI. This study explored whether genotype-guided selection of antiplatelet therapy improves outcomes in such patients.

Method

Overall, 50 patients with coronary atherosclerotic heart disease were randomly allocated to an observation group (n=25) or a control group (n=25). The control group received standard clopidogrel therapy. In the observation group, patients underwent CYP2C19 genotyping, and treatment was individualized by adjusting clopidogrel dosage or switching antiplatelet agents according to genotype. Clinical efficacy, incidence of major adverse cardiac events, and bleeding complications were evaluated.

Result

After 12 months, the observation group illustrated a consistently higher overall response rate when compared to the control group (P<0.05). Additionally, the rate of major adverse cardiac events was notably lower in the genotype-guided group (P<0.05). No prominent inter-group difference in bleeding-related adverse effects was found.

Conclusion

Tailoring antiplatelet therapy based on CYP2C19 genetic polymorphism improved clinical outcomes in coronary atherosclerotic heart disease, reduced cardiovascular risk, and offered greater overall therapeutic benefit without increasing bleeding complications.