Personalizing Antiplatelet Therapy
Currently, the evidence indicates that high platelet reactivity (HPR) and CYP2C19 LoF carriage are associated with poorer clinical outcomes in high-risk clopidogrel-treated patients who have undergone percutaneous coronary intervention (PCI). Therefore, a reasonable strategy is to assess platelet function and genetic testing in high-risk clopidogrel-treated patients and use more potent P2Y12 receptor therapy selectively in the patient with HPR. Platelet function testing may have a role to monitor (i) efficacy when clopidogrel is the chosen therapy and (ii) safety of long-term use of new more potent drugs especially in low-risk patients and patients with high bleeding risk. However, recent prospective, randomized trials have failed to demonstrate that personalized antiplatelet therapy based on platelet function is effective in reducing ischemic event occurrences. Thus, at this time we must rely on the guidelines and the existing observational data while keeping fully in mind the role that platelet physiology plays in catastrophic event occurrence in the stented patient.
