Pharmacogenomic Testing in a Bangladeshi Patient with Recurrent Cardiovascular Events Despite Clopidogrel Therapy: A Case Report

Specifically, high-risk cardiovascular patients are concerned with clopidogrel resistance due to CYP2C19 polymorphism. The genetic variation, however, lowers clopidogrel’s effectiveness in preventing thrombotic events by influencing how the drug is metabolized in the body. CYP2C19 polymorphism is prevalent in different populations, and the frequency is higher in South Asian individuals. This report describes a case of a Bangladeshi patient who had recurrent cardiovascular events while on clopidogrel therapy and adhered to the treatment. A 55-year-old Bangladeshi male with a history of cardiovascular disease presenting with multiple episodes of acute coronary syndrome (ACS) included a myocardial infarction and percutaneous coronary intervention (PCI). He had the strictest adherence to the clopidogrel therapy but suffered from ischemic events. His metabolic status about clopidogrel activation was assessed using Pharmacogenomic testing. This result confirmed that he was a poor metabolizer of clopidogrel by carrying a CYP2C19 LOF variant. The patient’s antiplatelet regimen was adjusted based on the pharmacogenomic findings and clopidogrel was replaced with ticagrelor, a more potent P2Y12 inhibitor that, unlike clopidogrel, does not require CYP2C19 activation. After six months of follow up, improved platelet function test results and prevention of further cardiovascular events were noted after the change in therapy. Pharmacogenomic testing to optimize antiplatelet therapy is important in this case because of its high prevalence of CYP2C19 LOF variants, and because treatment response is influenced by the polymorphism status of genes, as evidenced in this case. Routinely performing genetic screening in Bangladesh could both improve patient outcomes and lead to a personalizing approach to cardiovascular disease management.