Nav: Home

Mayo Clinic studying genomics of antiplatelet heart medication

July 28, 2016

ROCHESTER, Minn. -- Which antiplatelet medication is best after a coronary stent? The Tailored Antiplatelet Therapy to Lessen Outcomes After Percutaneous Coronary Intervention (TAILOR-PCI) Study examines whether prescribing heart medication based on a patient's CYP2C19 genotype will help prevent heart attack, stroke, unstable angina, and cardiovascular death in patients who undergo percutaneous coronary intervention (PCI), commonly called angioplasty.

TAILOR-PCI, which began in 2013 with study teams at 15 hospitals in the U.S., Canada and South Korea and plans to enroll 5,270 patients, just received an additional $7 million from the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH), to complete the study. Twenty nine medical centers are now participating with more to be added soon. The randomized comparison of Plavix (clopidogrel bisulfate) and Brilinta (ticagrelor) was launched by Mayo Clinic Center for Individualized Medicine and the Department of Cardiovascular Diseases at Mayo Clinic in collaboration with Peter Munk Cardiac Centre, University Health Network, Toronto, and Spartan Bioscience, Ottawa.

"The NHLBI grant is validation of the importance of the question that needs to be answered: Is pharmacogenomics useful in prescribing individualized anti-platelet therapy after PCI," says Naveen Pereira, M.D., Mayo Clinic cardiologist and principal investigator of TAILOR-PCI. "This study will tell us whether this gene plays an important role in determining response to anti-platelet therapy after coronary interventions."

Michael Farkouh, M.D., M.Sc., cardiologist, Peter Munk Cardiac Centre, University Health Network, and principal investigator, describes this large, simple trial as "a true multinational collaboration designed to best inform clinical practice."

Yves Rosenberg, M.D., the NHLBI program officer for the study, and chief of the Atherothrombosis and Coronary Artery Disease Branch, added, "NHLBI is happy to support this important study, which we hope will contribute to the evidence needed to start delivering precision medicine in clinical settings. This trial could have global impact by potentially changing treatment recommendations for millions of individuals with coronary artery disease needing antiplatelet treatment after a percutaneous coronary intervention."

The costly and potential life-or-death question lingers after most of the 600,000 angioplasties performed every year in the U.S. The current standard of care after angioplasty is to prescribe clopidogrel for one year.

"Today, we do this regardless of a person's individual genotype, even though we have known for several years that variation in the CYP2C19 gene may diminish the benefit from the drug," Dr. Pereira says. "What we don't know -- and why there is such confusion in the cardiovascular community -- is whether these genetic differences affect long-term clinical outcomes."

Antiplatelet medication reduces the risk of heart attack, unstable angina, stroke and cardiovascular death after stent placement by reducing the possibility of blood clots around the surgical site.

Clopidogrel, however, remains ineffective until the liver enzyme CYP2C19 metabolizes the drug into its active form. Some alternative medications, including ticagrelor, do not require activation through the same genetic pathway. Ticagrelor has its own risks, says Dr. Pereira, including serious or life-threatening bleeding. In addition, ticagrelor costs approximately six to eight times as much and must be taken twice a day, compared with clopidogrel.

"Answering this question is important for the most appropriate and best patient care, and it also will help physicians and patients use health care dollars most responsibly," says Chet Rihal, M.D., chair of cardiovascular services for Mayo Clinic and study chair.
-end-
About Mayo Clinic's Center for Individualized Medicine

The Center for Individualized Medicine discovers and integrates the latest in genomic, molecular and clinical sciences into personalized care for each Mayo Clinic patient. For more information, visit http://mayoresearch.mayo.edu/center-for-individualized-medicine/.

About Mayo Clinic

Mayo Clinic is a nonprofit organization committed to clinical practice, education and research, providing expert, whole-person care to everyone who needs healing. For more information, visit http://www.mayoclinic.org/about-mayo-clinic or http://newsnetwork.mayoclinic.org/.

Mayo Clinic

Related Heart Attack Articles:

Heart cells respond to heart attack and increase the chance of survival
The heart of humans and mice does not completely recover after a heart attack.
A simple method to improve heart-attack repair using stem cell-derived heart muscle cells
The heart cannot regenerate muscle after a heart attack, and this can lead to lethal heart failure.
Mount Sinai discovers placental stem cells that can regenerate heart after heart attack
Study identifies new stem cell type that can significantly improve cardiac function.
Fixing a broken heart: Exploring new ways to heal damage after a heart attack
The days immediately following a heart attack are critical for survivors' longevity and long-term healing of tissue.
Heart patch could limit muscle damage in heart attack aftermath
Guided by computer simulations, an international team of researchers has developed an adhesive patch that can provide support for damaged heart tissue, potentially reducing the stretching of heart muscle that's common after a heart attack.
How the heart sends an SOS signal to bone marrow cells after a heart attack
Exosomes are key to the SOS signal that the heart muscle sends out after a heart attack.
Heart attack patients taken directly to heart centers have better long-term survival
Heart attack patients taken directly to heart centers for lifesaving treatment have better long-term survival than those transferred from another hospital, reports a large observational study presented today at Acute Cardiovascular Care 2019, a European Society of Cardiology congress.
Among heart attack survivors, drug reduces chances of second heart attack or stroke
In a clinical trial involving 18,924 patients from 57 countries who had suffered a recent heart attack or threatened heart attack, researchers at the University of Colorado Anschutz Medical Campus and fellow scientists around the world have found that the cholesterol-lowering drug alirocumab reduced the chance of having additional heart problems or stroke.
Oxygen therapy for patients suffering from a heart attack does not prevent heart failure
Oxygen therapy does not prevent the development of heart failure.
I have had a heart attack. Do I need open heart surgery or a stent?
New advice on the choice between open heart surgery and inserting a stent via a catheter after a heart attack is launched today.
More Heart Attack News and Heart Attack Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Rethinking Anger
Anger is universal and complex: it can be quiet, festering, justified, vengeful, and destructive. This hour, TED speakers explore the many sides of anger, why we need it, and who's allowed to feel it. Guests include psychologists Ryan Martin and Russell Kolts, writer Soraya Chemaly, former talk radio host Lisa Fritsch, and business professor Dan Moshavi.
Now Playing: Science for the People

#538 Nobels and Astrophysics
This week we start with this year's physics Nobel Prize awarded to Jim Peebles, Michel Mayor, and Didier Queloz and finish with a discussion of the Nobel Prizes as a way to award and highlight important science. Are they still relevant? When science breakthroughs are built on the backs of hundreds -- and sometimes thousands -- of people's hard work, how do you pick just three to highlight? Join host Rachelle Saunders and astrophysicist, author, and science communicator Ethan Siegel for their chat about astrophysics and Nobel Prizes.