51
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Xie HG, Zou JJ, Hu ZY, Zhang JJ, Ye F, Chen SL. Individual variability in the disposition of and response to clopidogrel: Pharmacogenomics and beyond. Pharmacol Ther 2011; 129:267-89. [DOI: 10.1016/j.pharmthera.2010.10.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 10/06/2010] [Indexed: 01/08/2023]
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52
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Yamamoto K, Hokimoto S, Chitose T, Morita K, Ono T, Kaikita K, Tsujita K, Abe T, Deguchi M, Miyagawa H, Saruwatari J, Sumida H, Sugiyama S, Nakagawa K, Ogawa H. Impact of CYP2C19 polymorphism on residual platelet reactivity in patients with coronary heart disease during antiplatelet therapy. J Cardiol 2011; 57:194-201. [DOI: 10.1016/j.jjcc.2010.10.007] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 10/12/2010] [Accepted: 10/29/2010] [Indexed: 11/24/2022]
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53
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Lee JS, Ahn SW, Song JW, Shim JK, Yoo KJ, Kwak YL. Effect of Hydroxyethyl Starch 130/0.4 on Blood Loss and Coagulation in Patients With Recent Exposure to Dual Antiplatelet Therapy Undergoing Off-Pump Coronary Artery Bypass Graft Surgery. Circ J 2011; 75:2397-402. [DOI: 10.1253/circj.cj-11-0404] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jeong Soo Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine
| | - So Woon Ahn
- Department of Anesthesiology and Pain Medicine, Kwangdong University College of Medicine
| | - Jong Wook Song
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine
| | - Jae Kwang Shim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine
- Cardiovascular Research Institute, Yonsei University College of Medicine
| | - Kyung-Jong Yoo
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine
- Cardiovascular Research Institute, Yonsei University College of Medicine
| | - Young Lan Kwak
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine
- Cardiovascular Research Institute, Yonsei University College of Medicine
- Severance Biomedical Science Institute, Yonsei University College of Medicine
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54
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Sawada T, Shinke T, Shite J, Honjo T, Haraguchi Y, Nishio R, Shinohara M, Toh R, Ishida T, Kawamori H, Kozuki A, Inoue T, Hariki H, Hirata KI. Impact of Cytochrome P450 2C19*2 Polymorphism on Intra-Stent Thrombus After Drug-Eluting Stent Implantation in Japanese Patients Receiving Clopidogrel. Circ J 2011; 75:99-105. [DOI: 10.1253/circj.cj-10-0525] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Takahiro Sawada
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Toshiro Shinke
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Junya Shite
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Tomoyuki Honjo
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Yoko Haraguchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Ryo Nishio
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Masakazu Shinohara
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Ryuji Toh
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Tatsuro Ishida
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Hiroyuki Kawamori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Amane Kozuki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Takumi Inoue
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Hirotoshi Hariki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Ken-ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
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55
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Fu Q, Suzuki N, Takada K, Yamamoto H, Ishikawa S, Yokoyama N, Kozuma K, Isshiki T. Effect of cilostazol on optimized standard antiplatelet therapy in a patient with a cytochrome P450 2C19 *2/*2 genotype. Cardiovasc Interv Ther 2011; 26:79-82. [PMID: 24122505 DOI: 10.1007/s12928-010-0036-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Accepted: 09/01/2010] [Indexed: 11/24/2022]
Abstract
A 54-year-old man with acute coronary syndrome underwent primary percutaneous coronary intervention (PCI) to implant a bare metal stent. Three weeks later, a subclinical in-stent thrombus was found at staged PCI despite dual antiplatelet therapy with aspirin and clopidogrel. Platelet function tests revealed high post-treatment platelet reactivity, indicating an inadequate response to clopidogrel. The patient's cytochrome P450 2C19 genotype was *2/*2. Cilostazol at 200 mg/day was initiated in addition. Three months later, platelet inhibition was enhanced, and no thrombus was detectable by coronary angiography. Our experience suggests that triple antiplatelet therapy with cilostazol as well as aspirin and clopidogrel could prevent stent thrombosis with improved clopidogrel responsiveness.
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Affiliation(s)
- Qiang Fu
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
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56
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Close SL. Clopidogrel pharmacogenetics: metabolism and drug interactions. ACTA ACUST UNITED AC 2011; 26:45-51. [DOI: 10.1515/dmdi.2011.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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57
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Maeda A, Ando H, Asai T, Ishiguro H, Umemoto N, Ohta M, Morishima M, Sumida A, Kobayashi T, Hosohata K, Ushijima K, Fujimura A. Differential Impacts of CYP2C19 Gene Polymorphisms on the Antiplatelet Effects of Clopidogrel and Ticlopidine. Clin Pharmacol Ther 2010; 89:229-33. [DOI: 10.1038/clpt.2010.268] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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58
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Giusti B, Gori AM, Marcucci R, Abbate R. Relation of CYP2C19 loss-of-function polymorphism to the occurrence of stent thrombosis. Expert Opin Drug Metab Toxicol 2010; 6:393-407. [PMID: 20163283 DOI: 10.1517/17425251003598878] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IMPORTANCE OF THE FIELD Major adverse cardiovascular events including stent thrombosis associated with residual platelet reactivity on antiplatelet treatment in high risk vascular patients is a hot issue that needs a strong effort to be solved. Dual antiplatelet therapy with clopidogrel and aspirin prevents ischemic events and improves outcomes following acute coronary syndromes and percutaneous coronary intervention. However, adverse cardiovascular events occur in these patients, and several studies have shown that patients who suffer cardiovascular complications have high post-treatment platelet reactivity despite antiplatelet treatment. Clopidogrel requires conversion to active metabolite by CYP isoenzymes. Recently, CYP2C19*2 polymorphism (G681A nucleotide substitution) has been shown to be associated with decreased metabolisation of clopidogrel, poor antiaggregant effect and increased adverse cardiovascular events. AREAS COVERED IN THIS REVIEW This review summarises the principal studies contributing to establish the relationship between CYP2C19*2 polymorphism and adverse outcomes in high risk patients on clopidogrel treatment. TAKE HOME MESSAGE Prospective studies are urgently needed to determine the clinical impact of a score that takes into account individual characteristics of patients - CYP2C19*2 genotypes, residual platelet reactivity, drug-drug interaction, as well as traditional and procedural risk factors - for the identification of the therapeutic strategy that provides the best benefit for the single subject.
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Affiliation(s)
- Betti Giusti
- University of Florence and SOD Atherothrombotic Diseases, Department of Medical and Surgical Critical Care, AOU Careggi, Viale Morgagni 85, 50134 Florence, Italy.
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59
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Giusti B, Gori AM, Marcucci R, Saracini C, Vestrini A, Abbate R. Determinants to optimize response to clopidogrel in acute coronary syndrome. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2010; 3:33-50. [PMID: 23226041 PMCID: PMC3513207 DOI: 10.2147/pgpm.s5056] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Indexed: 12/23/2022]
Abstract
The inhibition of platelet function by antiplatelet therapy determines the improvement of the survival of patients with clinically evident cardiovascular disease. Clopidogrel in combination with aspirin is the recommended standard of care for reducing the occurrence of cardiovascular events in patients with acute coronary syndromes undergoing percutaneous coronary intervention. However, major adverse cardiovascular events including stent thrombosis occur in patients taking clopidogrel and aspirin. A growing body of evidence demonstrates that high post-treatment platelet reactivity on antiplatelet treatment is associated with increased risk of adverse clinical events. Clopidogrel requires conversion to active metabolite by cytochrome P450 isoenzymes. The active metabolite inhibits ADP-stimulated platelet activation by irreversibly binding to P2Y12 receptors. Recently, the loss-of-function CYP2C19*2 allele has been associated with decreased metabolization of clopidogrel, poor antiaggregant effect, and increased cardiovascular events. In high risk vascular patients, the CYP2C19*2 polymorphism is a strong predictor of adverse cardiovascular events and particularly of stent thrombosis. Prospective studies evaluating if an antiplatelet treatment tailored on individual characteristics of patients, CYP2C19*2 genotypes, platelet phenotype, drug–drug interaction, as well as traditional and procedural risk factors, are now urgently needed for the identification of therapeutic strategies providing the best benefit for the single subject.
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Affiliation(s)
- Betti Giusti
- Department of Medical and Surgical Critical Care, University of Florence, SOD Atherothrombotic Diseases, AOU Careggi, Florence, Italy
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60
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Dahl ML, Gunes A. Implications of Inter-Individual Differences in Clopidogrel Metabolism, with Focus on Pharmacogenetics. Pharmaceuticals (Basel) 2010; 3:782-794. [PMID: 27713279 PMCID: PMC4034010 DOI: 10.3390/ph3040782] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 03/09/2010] [Accepted: 03/22/2010] [Indexed: 01/21/2023] Open
Abstract
Increasing evidence for the role of pharmacogenetics in treatment resistance to the antiplatelet agent clopidogrel has been gained during the last years. Apart from CYP2C19 genetic polymorphisms, nongenetic factors, particularly drug-drug interactions, age and other clinical characteristics influence the interindividual variability in clopidogrel response to varying degrees. The present article reviews the so far accumulated evidence on the role of pharmacogenetic traits influencing CYP-activity as determinants of the antiplatelet response to clopidogrel, and its clinical implications. The genetic variation in CYP2C19 activity seems to influence short- and long-term antithrombotic effects of clopidogrel to a substantial extent. Prediction models for clopidogrel non-responsiveness that include CYP2C19 genotyping together with relevant non-genetic risk factors are needed to be verified for their potential benefit in individualization of antithrombotic therapy.
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Affiliation(s)
- Marja-Liisa Dahl
- Department of Medical Sciences, Clinical Pharmacology, Uppsala University, Uppsala, Sweden.
- Department of Clinical Pharmacology, Karolinska University Hospital, Huddinge C1:68, SE-141 86, Stockholm, Sweden.
| | - Arzu Gunes
- Department of Medical Sciences, Clinical Pharmacology, Uppsala University, Uppsala, Sweden
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61
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Nakagawa Y. What Is the Effectiveness of Drug-Eluting Stents in the Treatment of ST-Elevation Myocardial Infarction? - Should Drug-Eluting Stents Be Indicated for Patients With Acute Coronary Syndrome? (Pro) -. Circ J 2010; 74:2225-31. [DOI: 10.1253/circj.cj-10-0729] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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62
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Fu Q, Yokoyama N, Takada K, Ishikawa S, Isshiki T. Comparison of Platelet P2Y12 ADP Receptor-Mediated Pathway Inhibition in Triple Versus Dual Antiplatelet Therapy as Assessed by VASP-Phosphorylation in Japanese Patients Undergoing Coronary Stenting. Int Heart J 2010; 51:303-7. [DOI: 10.1536/ihj.51.303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Qiang Fu
- Division of Cardiology, Department of Internal Medicine, Teikyo University School of Medicine
| | - Naoyuki Yokoyama
- Division of Cardiology, Department of Internal Medicine, Teikyo University School of Medicine
| | - Kaoru Takada
- Division of Cardiology, Department of Internal Medicine, Teikyo University School of Medicine
| | - Shuichi Ishikawa
- Division of Cardiology, Department of Internal Medicine, Teikyo University School of Medicine
| | - Takaaki Isshiki
- Division of Cardiology, Department of Internal Medicine, Teikyo University School of Medicine
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