Genotype-Guided Antiplatelet Therapy: JACC Review Topic of the Week

Wout W.A. van den Broek, Brenden S. Ingraham, Naveen L. Pereira, Craig R. Lee, Larisa H. Cavallari, Jesse J. Swen, Dominick J. Angiolillo, Jurriën M. ten Berg*

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

Abstract

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.
Original languageEnglish
Pages (from-to)1107-1118
Number of pages12
JournalJournal of the American College of Cardiology
Volume84
Issue number12
DOIs
Publication statusPublished - 17 Sept 2024

Keywords

  • antiplatelet therapy
  • coronary artery disease
  • genotype-guided therapy
  • percutaneous coronary intervention
  • personalized medicine
  • pharmacogenomics

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