Pharmacogenetics of Clopidogrel in Acute Coronary Syndromes: CYP2C19 Polymorphisms in Brazilian Admixed Populations and Implications for Personalized Antiplatelet Therapy
DOI:
https://doi.org/10.36557/2674-8169.2026v8n2p202-222Keywords:
CYP2C19, Clopidogrel, Acute Coronary Syndrome, PharmacogeneticsAbstract
Introduction: Clopidogrel, a prodrug dependent on CYP2C19 bioactivation, remains important in acute coronary syndromes (ACS). Loss-of-function variants (*2, *3) reduce efficacy and increase ischemic risk; gain-of-function variants (*17) intensify antiplatelet effect. In Brazilian admixed populations, allelic distribution is heterogeneous, hindering clinical implementation. Objective: To synthesize literature on CYP2C19 polymorphisms relevant to clopidogrel in ACS, emphasizing Brazilian populations and implications for personalized therapy. Methodology: Narrative review in PubMed, Scopus, SciELO, and LILACS (2005–2026, prioritizing 2016–2026), including trials, observational studies, systematic reviews, Brazilian allelic frequency and outcome data, plus guidelines. Qualitative thematic synthesis. Results: Guidelines recommend avoiding clopidogrel in intermediate/poor metabolizers, favoring ticagrelor or prasugrel. Genotype-guided strategies reduce ischemic events without increasing bleeding. In Brazil, admixture generates individual ancestry variation, limiting clinical race proxies. Conclusion: In ACS in Brazil, CYP2C19 utility requires rapid results and integration into pragmatic algorithms. Implementation must be "ancestry-aware," clinically oriented and cost-sensitive, with research focused on hard outcomes in representative cohorts.
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Copyright (c) 2026 Vítor Rocha Leitão, Fernando Silva Galvão, Israel Dias Nonato, Gabriel Sebastião Pereira Baia de Almeida, Gabriel Lima Lôla, Juliana Mendes Coelho, Marcos Vinicius Ribeiro Lobato , Manuel Dionizio Bentes Monteiro Neto, Ney Athayde Pontes, Lucas Emanoel Couto Vogado, Gabriel César Jesus de Menezes, Reginaldo Costa da Silva Junior
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