Personalized approaches to clopidogrel therapy: are we there yet?
Personalized approaches to clopidogrel therapy: are we there yet?
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氯吡格雷疗法的个性化方法：我们在那里吗？
DOI：
10.1161/strokeaha.110.594069
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发表时间：
2010-12
期刊：
影响因子：
8.3
通讯作者：
Rosand J
中科院分区：
文献类型：
--
作者：
Anderson CD;Biffi A;Greenberg SM;Rosand J
氯吡格雷是全球最常用的处方药之一。美国食品药品监督管理局（FDA）最近的公告引起了人们对氯吡格雷候选人个性化决策的可能性的关注。与抗高血压药、他汀类药物和华法林一样，常见的基因序列变异体可影响氯吡格雷代谢及其对血小板活性的影响。在多项研究中，这些遗传变异与不良临床结局相关。合并用药也会影响身体对氯吡格雷的处理。质子泵抑制剂，广泛地与氯吡格雷一起使用，可能会减弱其有效性。我们根据积累的数据和当前FDA的规定，讨论了床边决策的影响，并得出结论，CYP2C19基因型的基因检测和PPI相互作用的限制似乎还没有提供一个机会，以优化治疗，鉴于目前的知识状态。
Clopidogrel is one of the most commonly prescribed medications world-wide. Recent advisories from the US Food and Drug Administration (FDA) have drawn attention to the possibility of personalized decision-making for individuals who are candidates for clopidogrel. As is the case with antihypertensives, statins and warfarin, common genetic sequence variants can influence clopidogrel metabolism and its effect on platelet activity. These genetic variants have, in multiple studies, been associated with adverse clinical outcomes. Concurrent medication use also influences the body's handling of clopidogrel. Proton pump inhibitors, widely prescribed in conjunction with clopidogrel, may blunt its effectiveness. We address implications for bedside decision-making in light of accumulated data and current FDA advisories, and conclude that genetic testing for CYP2C19 genotype and limitation of PPI interactions do not yet appear to offer an opportunity to optimize treatment given the current state of knowledge.