The role of CYP2C19 gene variants in the development of bleeding in patients receiving clopidogrel as part of dual antithrombotic therapy: a clinical case of a patient with coronary heart disease and atrial fibrillation after acute coronary syndrome

Valeria A. De , Alexey I. Kochetkov , Karin B. Mirzaev , Sherzod P. Abdullayev , Valeriy A. Konik , Olga D. Ostroumova , Dmitry A. Sychev

For citation:

Abstract

We present a clinical case of a 47-year-old man with coronary heart disease, arterial hypertension, type 2 diabetes mellitus and paroxysmal atrial fibrillation, who was prescribed dual antithrombotic therapy (DAT) – clopidogrel and rivaroxaban, after successful coronary stenting due to acute coronary syndrome (ACS). Not only routine examination was performed, but also the patient underwent pharmacogenetic testing to determine CYP2C19 genetic variants (rs4244285 – *2, rs4986893 – *3, and rs12248560 – *17). Bleeding was assessed retrospectively 17 weeks after acute coronary syndrome on the 1 visit and at follow-up visits (4, 8, 12, and 16 weeks). On the 1 visit the patient complained about nosebleeds and bruising <1 cm in diameter. During follow-up period nosebleeds lasting <10 minutes and bleeding from minor wounds lasting more than 5 minutes were found. All bleedings did not require medical intervention or withdrawal of DAT. According to the results of pharmacogenetic testing, the patient was a carrier of TT genotype of rs12248560, GG genotype of rs4244285, GG genotype of rs4986893 CYP2C19 gene, which corresponds to the phenotype – "ultrarapid metabolizer". This clinical case shows evidence of the association between CYP2C19*17 allele with a higher bleeding risk in patients taking DAT.
Keywords: acute coronary syndrome, atrial fibrillation, clopidogrel, pharmacogenetics, direct oral anticoagulants, CYP2C19, bleeding, adverse drug reactions, case report.

For citation:De V.A., Kochetkov A.I., Mirzaev K.B., Abdullaev Sh.P., Konik V.A., Ostroumova O.D., Sychev D.A. The role of CYP2C19 gene variants in the development of bleeding in patients receiving clopidogrel as part of dual antithrombotic therapy: a clinical case of a patient with coronary heart disease and atrial fibrillation after acute coronary syndrome. Clinical review for general practice. 2024; 5 (11): 49–54 (In Russ.). DOI: 10.47407/kr2024.5.11.00516

All accepted articles publish licensed under a Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.

Clinical review for general practice