Guided or Unguided Antiplatelet Therapy: Clarifying the Ambiguity

In patients with coronary artery disease, antiplatelet therapy is crucial for secondary prevention. Among the available P2Y12 inhibitors, clopidogrel is frequently preferred owing to its favourable safety profile and extensive clinical experience. Nevertheless, debates persist regarding its CYP2C19-mediated metabolism. While a number of clinical trials have been conducted to explore correlations between genotype and clinical outcomes, results have not been conclusive. Subsequent trials on platelet function test (PFT)-guided strategies showed limited benefit. International guidance, including the recent 2023 European Society of Cardiology guidelines for the management of acute coronary syndromes, question the clinical value of genotyping or PFT-guided antiplatelet strategies. Emphasising comprehensive patient profiles over genotype or PFT alone may better balance bleeding and ischaemic risks in antiplatelet therapy.