Pharmacogenomic- or Pharmacodynamic-Tailored Antiplatelet Therapy: Is it Time for Personalized Medicine?
Sunday, April 3, 2:00-3:30 PM
While clopidogrel is a successful antiplatelet drug for PCI patients, its ineffectiveness in certain patient subsets has recently been documented, spurring an FDA boxed warning. Testing patients' platelet responsiveness or their genotype has shown success, but which tests are most effective and efficacious? Further compounding these cath lab choices, newer antiplatelet agents loom as potential game changers.
Both genotypic and phenotypic testing hold promise, but the evidence for or against these tests is just beginning to emerge.
Recently reported data from the GRAVITAS trial found that a higher dose of clopidogrel did not seem to improve outcomes for poor responders. Some interventional cardiologists interpreted GRAVITAS to mean that platelet reactivity testing would gain more traction. Not everyone agrees.
"The impetus to change clinical practice will not be driven by negative treatment trials, but instead by clear treatment alternatives, which are proven to be effective," says former AHA President Raymond J. Gibbons, MD. "Currently, the problem is that there is no standardized platelet reactivity tests that are widely available and accepted."
Personalized medicine is the wave of the future. The challenges faced today with genotypic and phenotypic testing regarding clopidogrel will no doubt be solved in the near future. In the mean time, cardiologists and other cardiovascular professionals can freshen up on the current data and learn what is store in tailored-antiplatelet testing in this lively Q/A and debate-format session.
Speaker Information
-- Rebuttal: Antagonist
While clopidogrel is a successful antiplatelet drug for PCI patients, its ineffectiveness in certain patient subsets has recently been documented, spurring an FDA boxed warning. Testing patients' platelet responsiveness or their genotype has shown success, but which tests are most effective and efficacious? Further compounding these cath lab choices, newer antiplatelet agents loom as potential game changers.
Both genotypic and phenotypic testing hold promise, but the evidence for or against these tests is just beginning to emerge.
Recently reported data from the GRAVITAS trial found that a higher dose of clopidogrel did not seem to improve outcomes for poor responders. Some interventional cardiologists interpreted GRAVITAS to mean that platelet reactivity testing would gain more traction. Not everyone agrees.
"The impetus to change clinical practice will not be driven by negative treatment trials, but instead by clear treatment alternatives, which are proven to be effective," says former AHA President Raymond J. Gibbons, MD. "Currently, the problem is that there is no standardized platelet reactivity tests that are widely available and accepted."
Personalized medicine is the wave of the future. The challenges faced today with genotypic and phenotypic testing regarding clopidogrel will no doubt be solved in the near future. In the mean time, cardiologists and other cardiovascular professionals can freshen up on the current data and learn what is store in tailored-antiplatelet testing in this lively Q/A and debate-format session.
Speaker Information
- Matthew J. Price, MD, Scripps Clinic, La Jolla, Calif. -- Synthesis of Evidence for Pharmacodynamic Assessment
- Deepak L. Bhatt, MD, VA Boston Healthcare System -- Synthesis of Evidence for Pharmacogenomic Assessment
- Stephen D. Wiviott, MD, Harvard Medical School, Boston -- Pharmacogenomic Assessment Is Ready for Prime Time
- Paul A. Gurbel, MD, Sinai Center for Thrombosis Research, Baltimore -- Pharmacogenomic Assessment Is Not Ready for Prime Time
-- Rebuttal: Antagonist
- Michael A. Pacanowski, PharmD, MPH, FDA, Silver Spring, Md. -- FDA Perspective
- David R. Holmes, Jr., MD, Mayo Clinic, Rochester, Minn. -- ACC/AHA Perspective