Cytochrome P450 mutation reduces effectiveness of clopidogrel
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The CYP2C19 681G>A polymorphism (CYP2C19*2), a loss-of-function mutation in cytochrome P450—the enzyme that converts the prodrug clopidogrel to its active form—has been implicated in the attenuation of the antiplatelet activity of clopidogrel seen in some patients. Results of the EXCELSIOR trial suggest that CYP2C19*2 is associated with high on-treatment platelet reactivity and might, therefore, increase the risk of poor outcome after percutaneous coronary intervention.
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