Pharmacogenetic Testing for Clopidogrel: State of the ART
Claudia Saracini, Silvia Galora, Anna Maria Palombella, Rosanna Abbate and Betti Giusti
Affiliation: Department Experimental and Clinical Medicine, University of Florence, SOD Atherothrombotic Diseases, AOU Careggi, Largo Brambilla, 3, 50134 Florence, Italy.
Keywords: Acute coronary syndrome, clopidogrel, CYP2C19*2 polymorphism, pharmacogenetics, point-of-care, rapid test.
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.
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