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Application of Pharmacogenetics for the Use of Antiplatelet and Anticoagulant Drugs

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Abstract

Purpose of Review

This review summarizes the current state of knowledge regarding the pharmacogenetics of antiplatelet and anticoagulant medications. Barriers to clinical implementation and important research gaps in the field are also discussed.

Recent Findings

Two large prospective randomized clinical trials have been conducted in the percutaneous coronary intervention (PCI) population showing that CYP2C19-guided antiplatelet prescribing reduces ischemic and bleeding events. Clinical implementation barriers for widespread adoption included availability of a rapid turnaround CYP2C19 test and endorsement of testing by cardiology guidelines. Data are also emerging on the benefits of CYP2C19 testing for neurovascular indications. Three large prospective trials have been conducted on genetically guided warfarin dosing; the two studies that had positive outcomes were performed in mainly European populations. The third trial showed harm in participants of African ethnicity, limiting the clinical translation of warfarin pharmacogenetics.

Summary

Tremendous progress has been made in the discovery and clinical implementation of pharmacogenetics for personalizing antiplatelet and anticoagulant medications. Prospective pharmacogenetic testing is feasible, but important implementation barriers remain for widespread clinical adoption. The identification of variants influencing drug response in all ethnic groups is vital to ensure equity and not widen health disparities in the application of pharmacogenetics.

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Dr. Tuteja is supported by grants from the National Heart Lung Blood Institute (HL143161) and the Penn Center for Precision Medicine.

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  1. Department of Medicine, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street Maloney Building, Room 9013, Philadelphia, PA, 19104, USA

    Sony Tuteja

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Tuteja, S. Application of Pharmacogenetics for the Use of Antiplatelet and Anticoagulant Drugs. Curr Cardiovasc Risk Rep 17, 27–38 (2023). https://doi.org/10.1007/s12170-022-00713-y

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