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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
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Personalizing antiplatelet prescribing using genetics for patients undergoing percutaneous coronary intervention
1a Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics , University of Florida College of Pharmacy , Gainesville , FL , USA.
Expert Review of Cardiovascular Therapy
|July 13, 2017
Summary
Genetic variations in CYP2C19 significantly impact how patients respond to clopidogrel, a common antiplatelet medication. Genotype-guided therapy can personalize antiplatelet treatment after percutaneous coronary intervention (PCI) to improve outcomes.
Area of Science:
- Pharmacogenomics
- Cardiovascular Medicine
- Clinical Pharmacology
Background:
- Clopidogrel, used with aspirin, reduces cardiovascular events post-percutaneous coronary intervention (PCI).
- Inter-patient variability in clopidogrel response is significant.
- CYP2C19 genetic variations influence clopidogrel's activation and effectiveness.
Purpose of the Study:
- To review the impact of CYP2C19 genotype on clopidogrel pharmacokinetics, pharmacodynamics, and clinical effectiveness.
- To discuss clinical implementation and emerging outcomes of CYP2C19 genotype-guided antiplatelet therapy in PCI patients.
Main Methods:
- Review of existing literature on CYP2C19 genotype and clopidogrel response.
- Analysis of clinical data from observational studies, smaller trials, and ongoing large clinical trials.
Main Results:
- CYP2C19 genotype significantly affects clopidogrel's pharmacokinetic and pharmacodynamic profiles.
- Evidence suggests improved outcomes with genotype-guided antiplatelet therapy post-PCI.
- Alternative antiplatelet strategies are beneficial for patients with reduced clopidogrel effectiveness genotypes.
Conclusions:
- CYP2C19 genotyping can guide personalized antiplatelet therapy in patients undergoing PCI.
- Genotype-guided treatment holds promise for optimizing cardiovascular event risk reduction.
- Further data from large clinical trials are anticipated to solidify clinical recommendations.
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