Clinical outcomes of CYP2C19 genotype-guided antiplatelet therapy: existing evidence and future directions

Pharmacogenomics. 2018 Aug 1;19(13):1039-1046. doi: 10.2217/pgs-2018-0072. Epub 2018 Jul 20.


It is well established that the CYP2C19 nonfunctional *2 and *3 polymorphisms impair the bioactivation and antiplatelet effects of clopidogrel, and increase the risk of adverse cardiovascular events following percutaneous coronary intervention. In contrast, CYP2C19 genotype does not impact clinical response to prasugrel or ticagrelor. Recent studies have evaluated the impact of CYP2C19 genotype-guided selection of antiplatelet therapy on clinical outcomes and begun to close some of the gaps in knowledge and uncertainty that have impeded widespread clinical implementation of this precision medicine approach. This review will critically evaluate recent data and offer new insight into the potential clinical utility of genotype-guided antiplatelet therapy in the context of current clinical practice guidelines.

Keywords: CYP2C19; clopidogrel; guidelines; personalized medicine; pharmacogenomics; prasugrel; stent; ticagrelor.

Publication types

  • Review

MeSH terms

  • Acute Coronary Syndrome / genetics
  • Clopidogrel / adverse effects
  • Clopidogrel / therapeutic use
  • Cytochrome P-450 CYP2C19 / genetics*
  • Genotype
  • Humans
  • Percutaneous Coronary Intervention / methods
  • Platelet Aggregation Inhibitors / adverse effects
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Precision Medicine / methods


  • Platelet Aggregation Inhibitors
  • Clopidogrel
  • CYP2C19 protein, human
  • Cytochrome P-450 CYP2C19