Background:The association between cytochrome P450 (CYP) 2C19 genotypes and adverse events in patients treated with clopidogrel or prasugrel after percutaneous coronary intervention (PCI) in the Japanese population is unclear. First analysis of the relation between CYP2C19 genotype and pharmacodynamics in patients treated with ticagrelor versus clopidogrel: the ONSET/OFFSET and RESPOND genotype studies. Such CYPs can give false-negative results particularly with drugs such as clopidogrel that have high first-pass metabolism in the enterocyte. Additional variants, *4 and *5, also result in no enzymatic activity, but these variants are rare in all ethnicities (< 1%) and their effect on laboratory outcomes has not been fully documented. A reduction in hemoglobin is an independent cardiovascular risk factor.It also follows that patients with reduced function CYP2C19 alleles would then not be able to as effectively metabolize clopidogrel to the active thiol acid, as those with wild type alleles. The CYP2C19*17 allele is associated with better platelet response to clopidogrel in patients admitted for non-ST acute coronary syndrome. Varenhorst C, James S, Erlinge D, Brandt JT, Braun OO, Man M. Genetic variation of CYP2C19 affects both pharmacokinetic and pharmacodynamic responses to clopidogrel but not prasugrel in aspirin-treated patients with coronary artery disease. 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Woodfield Clinical Consulting LLC, Green Valley, AZ, 85622 USAUMDNJ‐RWJ Medical School, New Brunswick, NJ, 08903 USADr.

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