I'm writing for someone who had a stent put in some 7 months ago and has been put on the standard 'one size fits all' dose of Clopidogrel to reduce platelet aggregation and clots etc. Standard duration for such drugs after stents is 12 months.
Problem - the problem is that the Clopidogrel has horrible side effects - difficulty breathing, poor digestion, impaired pancreas function, extreme fatigue... etc etc. Life is not easy on Clopidogrel in this case.
Question - does anyone know anything or can help at all with looking at how to get a personalised dose of Clopidogrel - ie to take only as much as is needed to reduce platelet aggregation (or P2Y12 expression) the the required minimum in order to achieve no clotting around the stents
It seems that P2Y12 can be measured, but what and how, I cant' get to the bottom of, and what levels are required for clotting risk to be sufficiently reduced, I can neither get to the bottom of. It seems that not only does the Clopidogrel act differently on different people regarding the P2Y12 effect, of course, Clopidogrel is metabolised by CYP enzymes, which may work more or less efficiently in different people and therefore if they work less efficiently, the drug stays around for longer, and is like having a larger dose, which gives more side effects, and is a dose greater than that needed for adequate prevention. CYPs are also 'used up' by other pharamceutical drugs... of which there are at least 3 in this case competing. I suspect a smaller dose of Clopidogrel would be fine, but how small is very important, since clotting MUST be avoided as it is such a life threatening event.
Any help, insight or ideas appreciated, whether directly on the subject, or whether there are other forums or places to ask.....