What is the recommended antiplatelet therapy for a patient with a *1/*17 CYP2C19 genotype who has undergone two drug-eluting stent placements?

The best choice for a patient with a *1/*17 CYP2C19 genotype who has undergone two drug-eluting stent placements is ticagrelor. This recommendation is grounded in the understanding of how the CYP2C19 genotype affects the metabolism of various antiplatelet medications.

The *1/*17 genotype is characterized by one normal (wild-type) and one increased activity allele. Patients with this genotype often have an accelerated metabolism of clopidogrel. While standard-dose clopidogrel could potentially lead to adequate antiplatelet effects, the variability in metabolism due to the CYP2C19 genotype could increase the risk of insufficient platelet inhibition. Reduced doses of clopidogrel may not provide adequate antiplatelet activity due to this metabolic profile, potentially leading to a higher risk of thrombotic events.

On the other hand, both prasugrel and ticagrelor are independent of CYP2C19 metabolism. Ticagrelor, in particular, offers a faster onset of action and more consistent antiplatelet effect due to its mechanism of action, making it particularly suitable for patients requiring robust antiplatelet therapy post-stenting. Given this enhanced and reliable efficacy, ticagrelor is preferred