The need of a multicomponent guiding approach to personalize clopidogrel treatment
| Autor: | Accarino Giancarlo, Sellitto Carmine, Manzo Valentina, Iannaccone Teresa, Nicolella Giovanna, Torsiello Martina, Corbi Graziamaria, Conti Valeria, Costantino Maria, Filippelli Amelia |
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| Přispěvatelé: | Conti, Valeria, Sellitto, Carmine, Manzo, Valentina, Iannaccone, Teresa, Costantino, Maria, Torsiello, Martina, Accarino, Giancarlo, Nicolella, Giovanna, Corbi, Graziamaria, Filippelli, Amelia |
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Blood Platelets
0301 basic medicine medicine.medical_specialty Acute coronary syndrome CYP2C19 030226 pharmacology & pharmacy law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Genetics medicine Animals Humans cardiovascular diseases Precision Medicine Intensive care medicine Randomized Controlled Trials as Topic Pharmacology business.industry Animal Pharmacogenetic Vascular surgery Clopidogrel medicine.disease Cytochrome P-450 CYP2C19 Observational Studies as Topic 030104 developmental biology Pharmacogenetics Conventional PCI Molecular Medicine Blood Platelet Observational study business circulatory and respiratory physiology medicine.drug Human |
| Popis: | Patients bearing polymorphisms termed CYP2C19 loss of function (LoF) alleles and ABCB1-C3435T may do not properly respond to standard dosage of clopidogrel and have an increased risk of thrombosis. Moreover, co-administration of proton pump inhibitors (PPIs) and clopidogrel may attenuate the antiplatelet effect. The role of pharmacogenetics and PPIs/clopidogrel drug-drug interaction has been extensively investigated in patients with acute coronary syndrome after stent implantation (ACS/PCI), while data in patients undergoing vascular surgery are scarce. Here we have performed a systematic review to evaluate the available literature in such a clinical setting and have discussed the controversies about the use of CYP2C19 pharmacogenetics and platelet function testing to personalize clopidogrel treatment. In addition, we have made a comparison of the literature data with our findings concerning patients eligible for vascular surgery and treated with clopidogrel, in whom we used a combined management based on the CYP2C19 and ABCB1 pharmacogenetic testing with monitoring of therapeutic adherence and PPIs-clopidogrel interaction. Both our data and those produced during both observational studies and randomized clinical trials confirm the validity of pharmacogenetics to personalize clopidogrel treatment and stress the importance to make a drug monitoring considering all the known variables, potentially responsible for treatment failure. However, the American Heart Association and the European Cardiovascular Society recommend against the routine use of clopidogrel pharmacogenetic testing. An update of the international guidelines on antiplatelet therapy, incorporating the evidence related to CYP2C19 pharmacogenetics and PPIs-clopidogrel drug-drug interactions is warranted both in ACS/PCI patients and subjects undergoing vascular surgery. |
| Databáze: | OpenAIRE |
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