Rebecca A. Pulk
190 Welles St. Suite 128
Forty Fort, PA 18704
Institutional Affiliation: Geisinger Health System
NBER Working Papers and Publications
|May 2018||The Value of Cytochrome P450 2C19 Pharmacogenomic Information for Patients Receiving Clopidogrel Therapy Following a Major Cardiovascular Event: Evidence from Geisinger|
with Jove Graham, Frank R. Lichtenberg, Daniel Maeng, Marc S. Williams, Eric Wright
in Economic Dimensions of Personalized and Precision Medicine, Ernst R. Berndt, Dana P. Goldman, and John W. Rowe, editor
Dual antiplatelet therapy, combining a P2Y12 inhibitor and aspirin, is central to the management of patients with acute coronary syndromes. Clopidogrel is a commonly prescribed thienopyridine P2Y12 inhibitor used to prevent secondary events following a myocardial infarction / percutaneous coronary intervention. Clopidogrel effectiveness has been linked to proper function of metabolic enzyme cytochrome P450 2C19 (CYP2C19). Testing for CYP2C19 genetic changes that result in decreased activity has been proposed as a mechanism by which to identify clopidogrel non-responders a priori. Robust real-world studies evaluating the impact of genotype-guided antiplatelet selection on clinical, utilization and outcome metrics are lacking.
Approach: We linked clinical and financial data on a cohort of 2...