Clopidogrel Personalization: Pharmacogenetics and Pharmacometabonomics

Clopidogrel antiplatelet therapy is crucial for patients undergoing percutaneous coronary intervention. Attenuated response to clopidogrel may cause stent thrombosis and failure to therapeutic outcome. Prediction of Clopidogrel response can help personalize antiplatelet therapy. The CYP2C19 genetic polymorphism is one of the main factors interfering with clopidogrel response. Thus, the CYP2C19 genotyping was recommended to predict clopidogrel response. However, other environmental factors affect the response as well, often hindering response prediction using the CYP2C19 genotyping. Pharmacometabonomics analysis of biofluids is useful tool to indicate drug response novel biomarkers. It has the advantage of reflecting not only the genetic factors but also the environmental factors interfering with drug response. Therefore, pharmacometabonomics can be a preeminent approach to predict clopidogrel response. In this book, the literature on current methods to assess clopidogrel response is reviewed. Furthermore, the literature on using pharmacometabonomics to assess drug response and the rationale for using this approach in clopidogrel response prediction is reviewed and discussed.