TY - JOUR
T1 - Genotype-Guided Antiplatelet Therapy
T2 - JACC Review Topic of the Week
AU - van den Broek, Wout W.A.
AU - Ingraham, Brenden S.
AU - Pereira, Naveen L.
AU - Lee, Craig R.
AU - Cavallari, Larisa H.
AU - Swen, Jesse J.
AU - Angiolillo, Dominick J.
AU - ten Berg, Jurriën M.
N1 - Publisher Copyright:
© 2024 American College of Cardiology Foundation
PY - 2024/9/17
Y1 - 2024/9/17
N2 - The clinical efficacy and safety of antiplatelet agents vary among patients. Consequently, some patients are at increased risk of recurrent ischemic events during treatment. This interindividual variability can be a result of genetic variants in enzymes that play a role in drug metabolism. The field of pharmacogenomics explores the influence of these genetic variants on an individual's drug response. Tailoring antiplatelet treatment based on genetic variants can potentially result in optimized dosing or a change in drug selection. Most evidence supports guiding therapy based on the CYP2C19 allelic variants in patients with an indication for dual antiplatelet therapy. In ticagrelor-treated or prasugrel-treated patients, a genotype-guided de-escalation strategy can reduce bleeding risk, whereas in patients treated with clopidogrel, an escalation strategy may prevent ischemic events. Although the clinical results are promising, few hospitals have implemented these strategies. New results, technological advancements, and growing experience may potentially overcome current barriers for implementation in the future.
AB - The clinical efficacy and safety of antiplatelet agents vary among patients. Consequently, some patients are at increased risk of recurrent ischemic events during treatment. This interindividual variability can be a result of genetic variants in enzymes that play a role in drug metabolism. The field of pharmacogenomics explores the influence of these genetic variants on an individual's drug response. Tailoring antiplatelet treatment based on genetic variants can potentially result in optimized dosing or a change in drug selection. Most evidence supports guiding therapy based on the CYP2C19 allelic variants in patients with an indication for dual antiplatelet therapy. In ticagrelor-treated or prasugrel-treated patients, a genotype-guided de-escalation strategy can reduce bleeding risk, whereas in patients treated with clopidogrel, an escalation strategy may prevent ischemic events. Although the clinical results are promising, few hospitals have implemented these strategies. New results, technological advancements, and growing experience may potentially overcome current barriers for implementation in the future.
KW - antiplatelet therapy
KW - coronary artery disease
KW - genotype-guided therapy
KW - percutaneous coronary intervention
KW - personalized medicine
KW - pharmacogenomics
U2 - 10.1016/j.jacc.2024.06.038
DO - 10.1016/j.jacc.2024.06.038
M3 - (Systematic) Review article
SN - 0735-1097
VL - 84
SP - 1107
EP - 1118
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 12
ER -