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The American College of Cardiology Foundation / American Heart Association

The American College of Cardiology Foundation / American Heart Association

Clopidogrel Recommendations Clopidogrel Recommendations for Practicefor Practice

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Recommendations for PracticeRecommendations for PracticeRecommendations for PracticeRecommendations for Practice

• Adherence to existing ACCF/AHA guidelines for the use of Adherence to existing ACCF/AHA guidelines for the use of antiplatelet therapy should remain the foundation for therapy.antiplatelet therapy should remain the foundation for therapy.

• Clinicians must be aware that genetic variability in CYP Clinicians must be aware that genetic variability in CYP enzymes alter clopidogrel metabolism, which in turn can enzymes alter clopidogrel metabolism, which in turn can affect its inhibition of platelet function.affect its inhibition of platelet function.

• The specific impact of the individual genetic polymorphisms The specific impact of the individual genetic polymorphisms on clinical outcome remains to be determined.on clinical outcome remains to be determined.

• Information regarding the predictive value of Information regarding the predictive value of pharmacogenomic testing is very limited at this time; pharmacogenomic testing is very limited at this time; resolution of this issue is the focus of multiple ongoing resolution of this issue is the focus of multiple ongoing studies.studies.

David Holmes, et al, David Holmes, et al, ACCF/AHA Clinical Alert , 2010ACCF/AHA Clinical Alert , 2010

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Recommendations for PracticeRecommendations for PracticeRecommendations for PracticeRecommendations for Practice

• The evidence base is insufficient to recommend The evidence base is insufficient to recommend either routine genetic or platelet function testing at either routine genetic or platelet function testing at the present time.the present time.

• There are several possible therapeutic options for There are several possible therapeutic options for patients who experience an adverse event while patients who experience an adverse event while taking clopidogrel in the absence of any concern taking clopidogrel in the absence of any concern about medication compliance. about medication compliance.

• Alternative dosing strategies or newer antiplatelet Alternative dosing strategies or newer antiplatelet drugs could improve platelet inhibition and might drugs could improve platelet inhibition and might be considered.be considered.

David Holmes, et al, David Holmes, et al, ACCF/AHA Clinical Alert , 2010ACCF/AHA Clinical Alert , 2010

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ConclusionsConclusionsConclusionsConclusions

Because of a lack of evidence-based data, specific Because of a lack of evidence-based data, specific recommendations and strategies for routine genetic testing recommendations and strategies for routine genetic testing and identification of optimal care strategies cannot be and identification of optimal care strategies cannot be offered at this time.offered at this time.

““The evidence base is insufficient to recommend either The evidence base is insufficient to recommend either routine genetic or platelet function testing at the present routine genetic or platelet function testing at the present

time. There is no information that routine testing improves time. There is no information that routine testing improves outcome in large subgroups of patients. In addition, the outcome in large subgroups of patients. In addition, the

clinical course of the majority of patients treated with clinical course of the majority of patients treated with clopidogrel without either genetic testing or functional clopidogrel without either genetic testing or functional

testing is excellent. …Careful clinical judgment is required testing is excellent. …Careful clinical judgment is required to assess the importance of the variability in response to to assess the importance of the variability in response to

clopidogrel for an individual patient and its associated risk clopidogrel for an individual patient and its associated risk to the patient.”to the patient.”

David Holmes, et al, David Holmes, et al, ACCF/AHA Clinical Alert , 2010ACCF/AHA Clinical Alert , 2010