Personalized antiplatelet and Antithrombotic therapy

Antiplatelet therapy ( Aspirin and a P2Y12 inhibitors) has a crucial role in treatment of acute coronary syndromes (ACS). Resistance to Aspirin or clopidogrel may lead to increased risk of stent thrombosis, myocardial infarction and even death. Personalized antiplatelet therapy based on the genetic study is feasible even in daily clinical practice. The goal of antiplatelet therapy is prevention of thrombotic event with the least hemorrhagic complications. Therefore, there is a challenge between routine use of prasugrel/ticagrelor therapy, comparing to the clopidogrel genotype testing as a clinically and cost-effective management. Warfarin, which is the most commonly used vitamin K antagonist has a wide range of effective dose and effectiveness among the different population who need anticoagulant therapy. It has been shown that CYP2C9 and VKORC1 (known variants in genes) affect warfarin metabolism.Typically, dose adjustment for warfarin is based on the estimated given first dose and international normalized ratio testing, that needs frequent testing and dosing adjusted over time. It has been suggested that genetic testing might provide a clinical benefit in warfarin dosing decisions.However, warfarin-related variants have been mostly studied among western populations and warfarin dose variability seems to be higher in non -European populations.