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Clopidogrel, genotyping, coronary stenting, and guidelines
In the same week that Hulot et al published a meta-analysis reporting a high risk of events for CYP2C19*2 carriers taking clopidogrel, the ACC/AHA published guidelines stating that routine genetic or platelet-function testing is not recommended when using antiplatelet therapy. When we know that simple testing can tell us a lot about patient risk and there is a substantial data set to support testing, why do policy makers continue to ignore the importance of individualized medicine?
Disclosure: I serve as an advisor to Sanofi-Aventis, Daiichi Sankyo, and Quest Diagnostics.
See:
New meta-analysis: CYP2C19*2 carriers at higher risks of events on clopidogrel
Hulot JS, Collet JP, Silvain J, et al. Cardiovascular risk in clopidogrel-treated patients according to cytochrome P450 2C19*2 loss-of-function allele or proton pump inhibitor co-administration. A systematic meta-analysis. J Am Coll Cardiol 2010; 56:134-143.
No routine genetic or platelet-function testing for clopidogrel nonresponsiveness: ACC, AHA
Holmes DR, Dehmer GJ, Kaul S, et al. ACCF/AHA clopidogrel clinical alert: Approaches to the FDA "boxed warning." J Am Coll Cardiol 2010; DOI: 10.1016/j.jacc.2010.05.013. Available at: http://content.onlinejacc.org.
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Eric J Topol MD
Director, Scripps Translational Science Institute The Gary and Mary West Chair of Innovative Medicine Chief Academic Officer, Scripps Health La Jolla, CA |
Comments
CYP2C19*2 testing will become a critical part of patient management and guide the use of Clopidogrel. I could not be a greater agreement with your comments. Look for a full reversal and a recommendation for genetic testing in the future.
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