The potential of genotype-guided antiplatelet therapy: promises and challenges
Introduction: Presence of loss-of-function (LoF) allele of CYP2C19 gene has been associated with poor clopidogrel active metabolite generation, poor antiplatelet response, and elevated risk for cardiovascular events in patients treated with coronary stenting. The utility of genetic testing to identify patients with CYP2C19 LoF allele and alternative strategies to overcome its limitations during clopidogrel therapy are the focus of recent translational research studies. Areas covered: In this review, the authors discuss the relation of single nucleotide polymorphisms (SNPs) of CYP2C19 on clopidogrel pharmacology and their relation to clinical outcomes in coronary artery disease patients. They also discuss the methods available to assess CYP2C19 SNP’s, the current evidence available to support the genotype-guided antiplatelet therapy and its promises and challenges. Expert commentary: There is a strong potential for genetic testing during clopidogrel therapy in patients undergoing coronary stenting and to personalize antiplatelet therapy. A point-of-care assay is more suitable to assess CYP2C19 LoF allele. The optimal strategy to overcome the influence of LoF carriage in patients treated with clopidogrel is either prasugrel or ticagrelor, although randomized studies assessing this approach have not been performed.
