Pharmacogenomic considerations for antiplatelet agents: The era of precision medicine in stroke prevention and neurointerventional practice

Phillip A. Bonney, Benjamin Yim, Waleed Brinjikji, Brian P. Walcott

Research output: Contribution to journalReview article


Antiplatelet drugs are widely utilized in the setting of primary stroke prevention, secondary stroke prevention, and neuroendovascular device-related stroke prevention. These medications are effective in general, although significant variability in drug activity exists between patients. Although this variation may be related in part to a multitude of factors, a growing body of evidence suggests that individual genotypes are a main contributor. The PharmGKB database was mined to prioritize genetic variants with potential clinical relevance for response to aspirin, clopidogrel, prasugrel, and ticagrelor. Although variants were reported for all drugs, the highest level of evidence was found in cytochrome P450 (CYP450) genotype variation related to clopidogrel response. Individual genetic influences have an impact on the pharmacodynamics of antiplatelet agents. Current clinical practice for stroke prevention is primarily empiric or guided by functional assays; however, there now exists a third potential pathway to base treatment decisions: genotype-guided treatment.

Original languageEnglish (US)
Article numbera003731
JournalCold Spring Harbor Molecular Case Studies
Issue number2
StatePublished - Jan 1 2019


ASJC Scopus subject areas

  • Biochemistry
  • Molecular Medicine
  • Genetics
  • Genetics(clinical)

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