Evidence-Based Medicine, Pharmacogenetics, and Antiplatelet Therapy Decision Making for Acute Coronary Syndrome
Authors: John B. Wong
Journal: Annals of Internal Medicine (2014)

Editorials18 February 2014Evidence-Based Medicine, Pharmacogenetics, and Antiplatelet Therapy Decision Making for Acute Coronary SyndromeJohn B. Wong, MDJohn B. Wong, MDFrom Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M14-0040 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail The use of genetic information to support drug prescription decision making and avoid high-risk pharmacokinetic effects (1) is increasingly becoming a component of clinical care, suggesting the need for increasing physician education (2). The U.S. Food and Drug Administration identified more than 100 drugs with pharmacogenetic information on their labels (3). In 2010, the U.S. Food and Drug Administration issued a black box warning for clopidogrel regarding its reduced effectiveness in patients with certain CYP2C19 genetic polymorphisms (4). The U.S. Food and Drug Administration also alerted health care professionals to the availability of genetic tests and other antiplatelet medications or ...References1. Roden DM, Stein CM. Clopidogrel and the concept of high-risk pharmacokinetics [Editorial]. Circulation. 2009;119:2127-30. [PMID: 19398674] CrossrefMedlineGoogle Scholar2. Bartlett MJ, Green DW, Shephard EA. Pharmacogenetic testing in the UK clinical setting [Letter]. Lancet. 2013;381:1903. [PMID: 23725729] CrossrefMedlineGoogle Scholar3. Shuldiner AR, Relling MV, Peterson JF, Hicks JK, Freimuth RR, Sadee W, et al; Pharmacogenomics Research Network Translational Pharmacogenetics Program Group. The Pharmacogenomics Research Network Translational Pharmacogenetics Program: overcoming challenges of real-world implementation. Clin Pharmacol Ther. 2013;94:207-10. [PMID: 23588301] CrossrefMedlineGoogle Scholar4. U.S. Food and Drug Administration. FDA Drug Safety Communication: Reduced effectiveness of Plavix (clopidogrel) in patients who are poor metabolizers of the drug. 2010. Accessed at www.fda.gov/drugs/drugsafety/postmarketdrugsafetyinformationforpatientsandproviders/ucm203888.htm on 8 January 2014. Google Scholar5. Agency for Healthcare Quality and Research. Executive Summary: Testing of CYP2C19 Variants and Platelet Reactivity for Guiding Antiplatelet Treatment. Effective Health Care Program; 2013. Accessed at http://effectivehealthcare.ahrq.gov/search-for-guides-reviews-and-reports/?pageaction=displayproduct&productID=1725 on 8 January 2014. Google Scholar6. Gurbel PA, Tantry US. Do platelet function testing and genotyping improve outcome in patients treated with antithrombotic agents? Platelet function testing and genotyping improve outcome in patients treated with antithrombotic agents. Circulation. 2012;125:1276-87. [PMID: 22412089] CrossrefMedlineGoogle Scholar7. Krishna V, Diamond GA, Kaul S. Do platelet function testing and genotyping improve outcome in patients treated with antithrombotic agents? The role of platelet reactivity and genotype testing in the prevention of atherothrombotic cardiovascular events remains unproven. Circulation. 2012;125:1288-303. [PMID: 22412090] CrossrefMedlineGoogle Scholar8. Kazi DS, Garber AM, Shah RU, Dudley RA, Mell MW, Rhee C, et al. Cost-effectiveness of genotype-guided and dual antiplatelet therapies in acute coronary syndrome. Ann Intern Med. 2014;160:221-32. LinkGoogle Scholar9. World Health Organization. CHOosing Interventions that are Cost Effective (WHO-CHOICE): Cost-effectiveness thresholds. Accessed at www.who.int/choice/costs/CER_thresholds/en on 8 January 2014. Google Scholar10. McLeod HL, Isaacs KL. Preemptive pharmacogenetic testing: insufficient data equal unsatisfactory guidance [Editorial]. Ann Intern Med. 2011;154:842-4. [PMID: 21690601] LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Tufts Medical Center and Tufts University School of Medicine, Boston, Massachusetts.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0040.Corresponding Author: John B. Wong, MD, Tufts Medical Center, 800 Washington Street, Box 302, Boston, MA 02111; e-mail, [email protected]org. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCost-Effectiveness of Genotype-Guided and Dual Antiplatelet Therapies in Acute Coronary Syndrome Dhruv S. Kazi , Alan M. Garber , Rashmee U. Shah , R. Adams Dudley , Matthew W. Mell , Ceron Rhee , Solomon Moshkevich , Derek B. Boothroyd , Douglas K. Owens , and Mark A. Hlatky Cost-Effectiveness of Genotype-Guided and Dual Antiplatelet Therapies in Acute Coronary Syndrome Dhruv S. Kazi , Alan M. Garber , Rashmee U. Shah , R. Adams Dudley , Matthew W. Mell , Ceron Rhee , Solomon Moshkevich , Derek B. Boothroyd , Douglas K. Owens , and Mark A. Hlatky Metrics Cited ByWhich antiplatelet strategy for ACS? − it all depends 18 February 2014Volume 160, Issue 4Page: 284-285KeywordsAntiplatelet therapyDecision analysisDrug informationDrugsGenotypingPercutaneous coronary interventionPharmacogeneticsQuality of life ePublished: 18 February 2014 Issue Published: 18 February 2014 CopyrightCopyright © 2014 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...