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Tailoring Antiplatelet Treatment

Important advances have occurred in our understanding of the platelets’ role in arterial thrombosis. These advances have enabled the development of new antiplatelet therapies. Clinical trials have demonstrated the benefit of antiplatelet therapy in a diverse range of cardiovascular diseases (CVD), including acute myocardial infarction, unstable angina, and ischemic stroke. The market for antiplatelet therapies has grown in recent years for several reasons, including the: Aging population. Global increase in CVD incidence due to diabetes. Increased understanding of the role of antiplatelet therapy in the prevention and treatment of CVDs. Prasugrel and ticagrelor are two antiplatelet agents that have been recently approved by the FDA for use in conjunction with aspirin to treat patients with acute coronary artery syndromes. In phase III trials, these agents have been shown to significantly reduce adverse cardiovascular events when compared with clopidogrel therapy. These additions to the antiplatelet therapy class can make it more challenging for clinicians to decide on what is most appropriate and beneficial for their patients. There is no longer just one option for antiplatelet therapy. Clinicians must now consider the optimal antiplatelet therapy for each patient depending on their presentation, bleeding risk, and cost. Personalizing Approaches in Antiplatelet Treatment The unpredictable response to clopidogrel reported nearly a decade ago introduced us to the field of personalized antiplatelet therapy based on genetic and platelet function testing. The CYP2C19 loss-of-function allele is a major independent predictor of the pharmacodynamic and clinical response to clopidogrel in PCI patients. Guidelines and FDA recommendations suggest that patients who are poor metabolizers, according to CYP2C19 testing, should be switched to an alternate antiplatelet therapy. Genetic...
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