CardioExchange Archive

Routine Genotyping for Dual-Antiplatelet Therapy? Should genotyping be used routinely to guide dual-antiplatelet therapy (DAPT)? Two perspectives in the Journal of the American College of Cardiology provide starkly contrasting views of the issue. Samir Damani and Eric Topol, writing in a Viewpoint, note that genetic variations affecting clopidogrel responsiveness are quite common, and are “the root cause of adverse cardiovascular events during clopidogrel treatment.” Although the worth of genotyping has not been proven in large clinical trials, “we cannot afford to wait years for results from these trials that to date have yet to be initiated. In the interim, we should implement all potential interventions to help prevent the catastrophic outcomes of stent thrombosis and death in the tens of thousands of patients currently at risk.”

In an accompanying commentary, Paul Gurbel and colleagues also note the absence of clinical trials, and offer a number of reasons why the available data suggest that routine genotyping is not ready for prime time. They write that “the safety and efficacy of altering therapy in response to genotypic or phenotypic testing are entirely unknown,” and conclude that “ultimately, prospective randomized clinical trials will be needed to test specific personalized antiplatelet algorithms to provide the evidence base necessary for widespread adoption into clinical practice.”