CYP2C19-Guided DAPT De-Escalation: Cost Savings, No Clinical Signal
This single-center pilot trial tests whether genotype-guided ticagrelor-to-clopidogrel de-escalation changes bleeding or ischemic outcomes after ACS, and quantifies its drug-cost impact for anticoagulation pharmacists weighing implementation.
Genotype-guided antiplatelet therapy reduces costs without altering clinical outcomes.
Determining if pharmacogenetics can guide dual antiplatelet therapy (DAPT) de-escalation may optimize therapy by balancing bleeding risks and costs post-acute coronary syndrome (ACS). No significant differences in bleeding (10.7% vs. 12.0%) or ischemic events (13.3% vs. 14.7%) between genotype-guided and standard groups; cost savings noted. While cost-effective, genotype-guided de-escalation did not show significant clinical advantages over standard practice, indicating a need for larger studies. Genotype-guided therapy reduces costs but shows no significant clinical outcome differences over standard therapy.
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Authors:Turaev FK, Abdullaev SP, Matrenin KI, Gafurov FS, Tuchkova SN, Gabrielyan DA, Mirzaev KB, Kaprin DA, Sychev DA
Citation:Turaev FK, Abdullaev SP, Matrenin KI, et al. Pharmacogenetics-Guided De-Escalation of Dual Antiplatelet Therapy Based on CYP2C19 Testing in Patients After Acute Coronary Syndrome: Clinical Outcomes and Cost-Consequence Analysis. Journal of clinical medicine. 2026;15(18). doi:10.3390/jcm15187261
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Executive Summary
Study Design
Patient Population
Primary Outcomes
Secondary Outcomes & Safety Profile
Pharmacist Implications
Clinical Pearls
Limitations
Controversies & Evidence Gaps
Cost & Logistics
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