Jacobs Journal of Internal Medicine

Antiplatelet Pharmacogenomic Assessment in a Case of Coronary Artery Bypass

*Alessandro Buriani
Department Of Medicine, Gruppo Data Medica Padova, Padova, Italy

*Corresponding Author:
Alessandro Buriani
Department Of Medicine, Gruppo Data Medica Padova, Padova, Italy
Email:alessandro.buriani@gmail.com

Published on: 2017-02-08

Abstract

If not contraindicated, it is reasonable to use DAPT, starting in the CABG postoperative period, using ASA in association with clopidogrel. There is no specific guideline indicating pharmacogenomic testing for DAPT, but the FDA recommends it when using clopidogrel. In the present case pharmacogenomics was used for the evaluation of DAPT one year after CABG. The results indicate that despite the platelet hyper-responsiveness to ADP, clopidogrel might not be indicated, due to an increased P-gp dependent intestinal efflux, and its use should be reconsidered to substitute it with a different drug, like ticlopidine, or to administer it concomitant with P-gp antagonists.

Keywords

Personalized Medicine; Precision Medicine; Pharmacogenomics; Coronary Artery Disease; Platelet Aggregation; Antiplatelet therapy; Clopidogrel

Background

Though a growing number of guidelines for the application of pharmacogenomic testing for the personalization of therapies is available from national health agencies like FDA, these are still limited in number, despite the important information that can be obtained which can potentially improve the pharmacologic outcome. In the cardiovascular field multidrug associations are common; often to prevent life threatening conditions and pharmacogenomics could help the optimization of the effectiveness of therapeutic regimens.