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Clopidogrel, genotyping, coronary stenting, and guidelines

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Posted Jul 08, 2010 at 02:15 PM, EDT by Eric Topol

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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Maybe it will take a lawsuit for clinicians to change their practice.
Posted by PG, Jul 19, 2010 at 03:32 PM, EDT
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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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Posted by Dr. Walt, Aug 10, 2010 at 06:56 PM, EDT
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