Clopidogrel Dosing Based on Genotype: What Difference Does It Make?

In patients heterozygous for the CYP2C19*2 allele, higher doses significantly reduced platelet reactivity, but whether genotype-guided dosing improves outcomes remains unknown.

Genetic variation in liver cytochrome PY450 enzymes affects individuals' pharmacologic and clinical response to clopidogrel. However, no effective treatment strategy for poor metabolizers of clopidogrel has yet been validated in clinical trials. To assess the effects of escalating doses of clopidogrel on platelet reactivity according to CYP2C19 genotype, investigators conducted an industry-funded trial in 333 patients (mean age, 60; 75% men) with stable coronary artery disease. Fifty-seven percent of patients had a history of myocardial infarction, and 97% had undergone percutaneous coronary intervention.

After genotyping and platelet function testing, participants were allocated to a sequence of maintenance clopidogrel doses for four 2-week…

Reviewing Author

Joel M. Gore, MD

Disclosures

Grant/Research SupportNIH–National Heart, Lung, and Blood Institute

Joel M. Gore, MD

Disclosures

Grant/Research SupportNIH–National Heart, Lung, and Blood Institute