Cytochrome P450 2C19
CYP2C19geneCYP2C19 genetic variants regulate clopidogrel activation, modulating platelet aggregation inhibition and stent thrombosis risk after coronary intervention.
Pathway placement
Cascade stepPlatelet adhesion & activation
Confidencehigh
RationaleMetabolizes clopidogrel to active inhibitor; mediates platelet P2Y12-receptor antagonism and thrombus prevention.
Also acts inThromboxane / COX-1
Druggability
DruggableYes
Known drugs / candidates0
Small-molecule tractableYes
Antibody tractableYes
EnsemblENSG00000165841
Type I vs Type II discrimination
ScoresLow-confidence (proxy)
R — rupture / Type-I85
C — confounder / Type-II63
A — assay feasibility52
E — evidence strength32
T1DI (composite)10
Specificity differential (R−C)+21.6
Confounder panel (Type-II drivers)
No confounder evidence retrieved.
Tier: light (literature co-occurrence proxy — lower confidence). See the discrimination table for all markers.
Assay & specimen
Class-level default (no specific cleared assay)— generic method inferred from analyte class; confirm against a specific product insert before use.
Specimen
Whole blood — gene is not a circulating analyte; measure protein product or genotype
Collection tube
K2-EDTA whole blood (lavender-top)
Method / principle
SNP genotyping / sequencing; or immunoassay of encoded protein
Reagent / substrate
Allele-specific primers/probes (TaqMan) or NGS panel; or antibody for protein
Platform
qPCR / NGS / array
Turnaround · availability
Send-out · Genotyping widely available; protein assay variable
Human genetic evidence
0.007
Open Targets association (NSTEMI)
Literature evidence(3)
- Emerging genomic applications in coronary artery disease.JACC. Cardiovascular interventions · 2011 · PMID 21596318 · doi
- Genetic determinants of on-clopidogrel high platelet reactivity.Platelets · 2011 · PMID 21627411 · doi
- Recent advances in the pharmacogenetics of clopidogrel.Human genetics · 2011 · PMID 22207144 · doi
Clinical trials(8)
- Cost-effectiveness of CYP2C19 Genotype Guided Treatment With Antiplatelet Drugs in Patients With ST-segment-elevation Myocardial Infarction Undergoing Immediate PCI With Stent Implantation: Optimization of Treatment (POPular Genetics).NCT01761786 · PHASE4 · COMPLETED · CYP2C19 genotyping
- Assessment of Prospective CYP2C19 Genotype Guided Dosing of Anti-Platelet Therapy in Percutaneous Coronary Intervention (ADAPT)NCT02508116 · NA · COMPLETED · CYP2C19 genotyping
- Pharmacogenetics of Clopidogrel in Acute Coronary SyndromesNCT03347435 · NA · TERMINATED · genetic tests for CYP2C19*2, CYP2C19*17 and ABCB1 3435, clinical algorithm
- Adopting a Precision Medicine Paradigm in Puerto Rico: Leveraging Ancestral Diversity to Identify Predictors of Clopidogrel Response in Caribbean HispanicsNCT03419325 · EARLY_PHASE1 · COMPLETED · CYP2C19 test, P2RY12 assay
- CYP2C19 Genotype-GUided Dual Antiplatelet theRapy in pAtieNts Treated With New Generation Drug Eluting stEnts (the GUARANTEE Study)NCT03783351 · NA · ACTIVE_NOT_RECRUITING · CYP2C19 genotype testing
- Implementing Precision Medicine Approaches to Guide Anti-platelet Selection Following Percutaneous Coronary Intervention (PCI)NCT04090281 · PHASE4 · UNKNOWN · CYP2C19 genotyping
- Safety and Efficacy of CYP2C19 Genotype-Guided P2Y12 Receptor Inhibitor Selection Versus Conventional Antiplatelet Therapy After Complex Percutaneous Coronary Intervention: The PRECISE-PCI Randomized Clinical TrialNCT06283888 · PHASE4 · RECRUITING · CYP2C19 Genotype Guided DAPT, Conventional DAPT
- Pharmacogenomic Markers of Clopidogrel Resistance in Malaysian CAD Patients: Clinical Efficacy and Economic Evaluation of CYP2C19 Genotype-Guided TherapyNCT06759272 · PHASE4 · NOT_YET_RECRUITING · CYP2C19 genotype-guided antiplatelet therapy