Pharmacogenetic Testing for Clopidogrel: State of the ART

Claudia      Saracini; Silvia      Galora; Anna   Maria   Palombella; Rosanna      Abbate; Betti      Giusti

doi:10.2174/18756921113119990002

Abstract

Dual antiplatelet therapy with aspirin and clopidogrel is a standard care to reduce the risk of recurrent cardiovascular events in patients with acute coronary syndrome (ACS). The dual treatment has demonstrated substantial benefit in patients undergoing percutaneous coronary intervention (PCI) and stent implantation. Despite adequate treatment, major adverse cardiovascular events (MACE) occur in about 10% of patients on dual antiplatelet therapy. Genetic variants in CYP2C19 gene have been associated with residual platelet reactivity on-clopidogrel treatment and adverse outcomes in high risk vascular patients. The introduction of pharmacogenetic tests, in addition to platelet function test, could provide the clinician with an additional tool to make decisions on differentiated therapeutic strategies, tailored antiplatelet therapy, modeled on the individual characteristics of the patients, amplifying the concept of "personalized medicine”. The use of genetic test for the identification of CYP2C19^*2 and other polymorphisms involved in the pharmacogenetics of clopidogrel could thus be useful to improve the risk stratification of patients, guide clinicians in the choice for alternative antiplatelet therapy, and therapeutic management of patients, and consequently to reduce the occurrence of MACE in patients with ACS. Rapid point of care genetic tests would be desirable to allow cardiologists and primary care physicians to obtain a rapid genetic profile of patients under treatment and integrate this information in an accurate predictive algorithm to achieve truly antiplatelet personalized care. This expert review provides an analysis of the currently available biotechnologies for clopidogrel pharmacogenetics testing and what we can anticipate in the near future for personalized medicine.

Keywords: Acute coronary syndrome, clopidogrel, CYP2C19^*2 polymorphism, pharmacogenetics, point-of-care, rapid test.

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