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Patients with loss of function (LOF) variants of the CYP2C19 gene have decreased serum levels of clopidogrel after oral administration. Consequently, platelet reactivity in these patients remain higher, when compared to patients with wild-type CYP2C19. With a less-potent platelet inhibition, clot formation would continue to occur and these patients would remain more vulnerable to recurrent ischaemic events. Test for both platelet reactivity and the CYP2C19 genetic variant are currently available, and have the theoretical potential to help clinicians to better choose the anti-platelet agent to be used, but the clinical evidence behind their use is still limited, preventing guidelines from routinely recommending these tests.

Personalised Approaches to Improving the Effect of Anti-platelet Agents: Where Do We Stand?