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Clopidogrel is a prodrug which is converted into active metabolite by cytochrome P450 isoenzyme,  CYP2C19 . Numerous polymorphisms of  CYP2C19  are reported, and a strong link exists between loss-of-function (LOF) or gain-of-function polymorphisms, clopidogrel metabolism, and clinical outcome. Hence, a fully automated point-of-care CYP2C19 genotyping assay is more likely to bring personalized antiplatelet therapy into real practice. We assessed the feasibility of the Verigene 2C19/CBS Nucleic Acid Test, a fully automated microarray-based assay, compared to bidirectional sequencing, and performed VerifyNow P2Y12 assay to evaluate the effect of  CYP2C19  polymorphisms on on-treatment platelet reactivity in 57 Korean patients treated with clopidogrel after percutaneous coronary intervention. The Verigene 2C19/CBS assay identified ∗2, ∗3, and ∗17 polymorphisms with 100% concordance to bidirectional sequencing in 180 minutes with little hands-on time. Patients were classified into 4 groups: extensive (∗1/∗1;  n  = 12, 21.1%), intermediate (∗1/∗2, ∗1/∗3;  n  = 33, 57.9%), poor (∗2/∗2, ∗2/∗3, and ∗3/∗3;  n  = 11, 19.3%), and ultrarapid metabolizers (∗1/∗17;  n  = 1, 1.8%). The prevalence of the  CYP2C19   ∗2, ∗3, and ∗17 alleles was 36.0%, 12.3%, and 0.9%. Platelet reactivity showed gene dose response according to the number of  CYP2C19  LOF allele. In conclusion, the Verigene 2C19/CBS assay gave accurate  CYP2C19  genotype results which were in well match with the differing on-treatment platelet reactivity.

Feasibility of a Microarray-Based Point-of-CareCYP2C19Genotyping Test for Predicting Clopidogrel On-Treatment Platelet Reactivity