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Response variability to clopidogrel: is tailored treatment, based on laboratory testing, the right solution?
1Dipartimento di Medicina, Chirurgia e Odontoiatria, Università degli Studi di Milano, Unità di Medicina 3, Ospedale San Paolo, Milan, Italy. marco.cattaneo@unimi.it
Journal of Thrombosis and Haemostasis : JTH
|January 7, 2012
Summary
Clopidogrel response varies significantly due to genetics and environment, impacting its effectiveness. Tailoring treatment with lab tests requires further validation before clinical use.
Area of Science:
- Pharmacology
- Clinical Medicine
- Biochemistry
Background:
- Clopidogrel is an antithrombotic prodrug targeting the P2Y12 receptor.
- Significant inter-individual variability exists in patient response to clopidogrel.
- Approximately one-third of patients exhibit suboptimal platelet inhibition.
Purpose of the Study:
- To analyze the variability in clopidogrel response.
- To evaluate the potential of tailored treatment based on laboratory tests.
- To discuss the clinical implications and future directions for clopidogrel therapy.
Main Methods:
- Review of existing studies on clopidogrel response variability.
- Analysis of factors contributing to variable drug metabolism and absorption.
- Discussion of laboratory testing for platelet function monitoring.
Main Results:
- Genetic and environmental factors significantly influence clopidogrel's efficacy.
- Suboptimal response rates highlight a clinical challenge.
- Tailored therapy using lab tests is proposed but lacks proven efficacy.
Conclusions:
- Alternative drugs with predictable bioavailability may be preferred.
- Tailored clopidogrel therapy requires rigorous validation through randomized clinical trials.
- Standardization of laboratory tests and assessment of clinical utility and cost-effectiveness are essential.
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