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Shi HT, Chen YY, Li XY, Luo JH, Zhong GH, Hu JJ, Zhang M, Zhou BR. The Dynamic Effect of Non-CYP3A4-Metabolized and CYP3A4-Metabolized Statins on Clopidogrel Resistance in Patients With Cerebral Infarction. Front Pharmacol 2021; 12:738562. [PMID: 34690774 PMCID: PMC8526974 DOI: 10.3389/fphar.2021.738562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/16/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To explore the treatment effect of statins used together with clopidogrel on cerebral infarction (CI). Methods: One hundred and thirty non-clopidogrel resistant patients were divided into a dynamic clopidogrel resistant (DCR) group and a continuous Non clopidogrel resistance (NCR) group. Patients were randomly assigned to AC group (atorvastatin 40 mg/d + clopidogrel, 51 patients) and RC group (rosuvastatin 20 mg/d + clopidogrel, 47 patients). The patient’s platelet aggregation rate (PAR) was measured on visit 0 (baseline), visit 1 (1 week after clopidogrel alone treatment), and visits 2 to 4 (one, three, and 6 months after clopidogrel plus statins treatment). The platelet reactivity index (PRI) was assessed on visits 0, 2, and 4, and clopidogrel thiol metabolite (H4) levels was measured on visits 2 and 4. DNA sequencing was used to determine CYP3A4, CYP2C9, and CYP2C19 genotypes in all patients. Results: PAR, PRI, and H4 levels, DCR ratio, and the genotype frequencies of CYP2C9*3εC, CYP2C19*2εA, and CYP2C19*3εA of both groups were similar (p > 0.05). CYP2C19εA *2 and *3 were independent risk factors for DCR (p < 0.05). Conclusion: Clopidogrel combined with atorvastatin does not affect platelet inhibition and does not increase the incidence of DCR. The incidence of DCR in the Chinese population is high and is related to CYP2C19εA.
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Affiliation(s)
- Hong Ting Shi
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yong Yuan Chen
- Department of Neurology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xiao Ying Li
- Department of Neurology, The Shunde Affiliated Hospital of Jinan University, Shunde, China
| | - Jian Hua Luo
- Department of Neurology, Yangchun People Hospital, Yangchun, China
| | | | - Jia Jia Hu
- Department of Neurology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Min Zhang
- Department of Epidemiology and Health Statistics, Guangdong Pharmaceutical University, Guangzhou, China
| | - Bo Rong Zhou
- Department of Neurology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Greger J, Wojcik R, Westphal E, Aladeen T, Landolf K, Boyce S, Rainka M, Gengo F, Bates V. Pharmacist intervention and
anti‐platelet
medication monitoring in patients following stroke and transient ischemic attack. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2021. [DOI: 10.1002/jac5.1378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jessica Greger
- Department of Neuropharmacology Dent Neurologic Institute Amherst New York USA
- School of Pharmacy and Pharmaceutical Sciences University at Buffalo Buffalo New York USA
| | - Rachael Wojcik
- Department of Neuropharmacology Dent Neurologic Institute Amherst New York USA
| | - Erica Westphal
- Department of Neuropharmacology Dent Neurologic Institute Amherst New York USA
| | - Traci Aladeen
- Department of Neuropharmacology Dent Neurologic Institute Amherst New York USA
- School of Pharmacy and Pharmaceutical Sciences University at Buffalo Buffalo New York USA
| | - Kaitlin Landolf
- Department of Neuropharmacology Dent Neurologic Institute Amherst New York USA
- School of Pharmacy and Pharmaceutical Sciences University at Buffalo Buffalo New York USA
| | - Samantha Boyce
- Department of Neuropharmacology Dent Neurologic Institute Amherst New York USA
- School of Pharmacy and Pharmaceutical Sciences University at Buffalo Buffalo New York USA
| | - Michelle Rainka
- Department of Neuropharmacology Dent Neurologic Institute Amherst New York USA
- School of Pharmacy and Pharmaceutical Sciences University at Buffalo Buffalo New York USA
| | - Fran Gengo
- Department of Neuropharmacology Dent Neurologic Institute Amherst New York USA
- School of Pharmacy and Pharmaceutical Sciences University at Buffalo Buffalo New York USA
| | - Vernice Bates
- Department of Neuropharmacology Dent Neurologic Institute Amherst New York USA
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Shi GX, Zhao ZH, Yang XY, Lin M, Chen ZX. Correlation study of CYP2C19 gene polymorphism and clopidogrel resistance in Han Chinese patients with cerebral infarction in Guizhou region. Medicine (Baltimore) 2021; 100:e24481. [PMID: 33578542 PMCID: PMC7886463 DOI: 10.1097/md.0000000000024481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 12/31/2020] [Indexed: 01/05/2023] Open
Abstract
This study conducts a correlation exploration of CYP2C19 gene polymorphism and clopidogrel resistance in Han Chinese patients with cerebral infarction in Guizhou Region.A total of 270 Han Chinese patients with cerebral infarction, who were hospitalized in our hospital from January 2016 to January 2018, are selected. These patients were divided into 2 groups, clopidogrel resistance group (n = 60) and clopidogrel sensitive group (n = 210). According to the TEG results, the CYP2C19 gene polymorphism detection was carried out by using the PCR-RFLP method, while IL-6 level in the patient's blood was measured by using the ELISA method.The resistance group occupies 22.22%. The platelet inhibition ratio of the resistance group was 23 ± 7%, which was significantly lower than that of the sensitive group (65 ± 13%), and the difference was statistically significant (P < .05). The Logisitic regression analysis revealed that the history of diabetes, history of high blood pressure, increase in low density lipoprotein and CYP2C19 mutant gene were independent risk factors of clopidogrel resistance. After treatment, the serum IL-6 level of patients in the resistance group was 17.21 ± 0.98 ng/L, which was significant higher than that of patients in the sensitive group (11.21 ± 0.68 ng/L), and the difference was statistically significant (P < .05).Patients with cerebral infarction in Guizhou region have a higher occurrence rate of clopidogrel resistance. Clopidogrel resistance not only will weaken the anti-inflammatory action of the drug, but also correlates with the patient's CYP2C19 mutant gene and blood lipid level.
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Affiliation(s)
- Guo-Xian Shi
- Department of Neurology, Guizhou Aerospace Hospital, Zunyi
| | - Zi-He Zhao
- Department of Dermatology, Beijing Chinese Medicine Hospital Affiliated to Capital Medical University, Beijing, China
| | - Xiao-Yan Yang
- Department of Neurology, Guizhou Aerospace Hospital, Zunyi
| | - Mu Lin
- Department of Neurology, Guizhou Aerospace Hospital, Zunyi
| | - Zhou-Xue Chen
- Department of Neurology, Guizhou Aerospace Hospital, Zunyi
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Rosafio F, Lelli N, Mimmi S, Vandelli L, Bigliardi G, Dell'Acqua ML, Picchetto L, Pentore R, Ferraro D, Trenti T, Nichelli P, Zini A. Platelet Function Testing in Patients with Acute Ischemic Stroke: An Observational Study. J Stroke Cerebrovasc Dis 2017; 26:1864-1873. [PMID: 28576652 DOI: 10.1016/j.jstrokecerebrovasdis.2017.04.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 04/21/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The measurement of platelet reactivity in patients with stroke undergoing antiplatelet therapies is not commonly performed in clinical practice. We assessed the prevalence of therapy responsiveness in patients with stroke and further investigated differences between patients on prevention therapy at stroke onset and patients naive to antiplatelet medications. We also sought differences in responsiveness between etiological subtypes and correlations between Clopidogrel responsiveness and genetic polymorphisms. METHODS A total of 624 stroke patients on antiplatelet therapy were included. Two different groups were identified: "non-naive patients", and "naive patients". Platelet function was measured with multiple electrode aggregometry, and genotyping assays were used to determine CYP2C19 polymorphisms. RESULTS Aspirin (ASA) responsiveness was significantly more frequent in naive patients compared with non-naive patients (94.9% versus 82.6%, P < .0010). A better responsiveness to ASA compared with Clopidogrel or combination therapy was found in the entire population (P < .0010), in non-naive patients (P < .0253), and in naive patients (P < .0010). Multivariate analysis revealed a strong effect of Clopidogrel as a possible "risk factor" for unresponsiveness (odds ratio 3.652, P < .0001). No difference between etiological subgroups and no correlations between responsiveness and CYP2C19 polymorphisms were found. CONCLUSION In our opinion, platelet function testing could be potentially useful in monitoring the biological effect of antiplatelet agents. A substantial proportion of patients with stroke on ASA were "resistant", and the treatment with Clopidogrel was accompanied by even higher rates of unresponsiveness. Longitudinal studies are needed to assess whether aggregometry might supply individualized prognostic information and whether it can be considered a valid tool for future prevention strategies.
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Affiliation(s)
- Francesca Rosafio
- Stroke Unit, Neurology Clinic, Department of Neuroscience, Nuovo Ospedale Civile S. Agostino-Estense, University Hospital of Modena, Modena, Italy
| | - Nicoletta Lelli
- Clinical Pathology-Toxicology, Nuovo Ospedale Civile S. Agostino-Estense, University Hospital of Modena, Modena, Italy
| | | | - Laura Vandelli
- Stroke Unit, Neurology Clinic, Department of Neuroscience, Nuovo Ospedale Civile S. Agostino-Estense, University Hospital of Modena, Modena, Italy
| | - Guido Bigliardi
- Stroke Unit, Neurology Clinic, Department of Neuroscience, Nuovo Ospedale Civile S. Agostino-Estense, University Hospital of Modena, Modena, Italy
| | - Maria Luisa Dell'Acqua
- Stroke Unit, Neurology Clinic, Department of Neuroscience, Nuovo Ospedale Civile S. Agostino-Estense, University Hospital of Modena, Modena, Italy
| | - Livio Picchetto
- Stroke Unit, Neurology Clinic, Department of Neuroscience, Nuovo Ospedale Civile S. Agostino-Estense, University Hospital of Modena, Modena, Italy
| | - Roberta Pentore
- Stroke Unit, Neurology Clinic, Department of Neuroscience, Nuovo Ospedale Civile S. Agostino-Estense, University Hospital of Modena, Modena, Italy
| | - Diana Ferraro
- Stroke Unit, Neurology Clinic, Department of Neuroscience, Nuovo Ospedale Civile S. Agostino-Estense, University Hospital of Modena, Modena, Italy
| | - Tommaso Trenti
- Clinical Pathology-Toxicology, Nuovo Ospedale Civile S. Agostino-Estense, University Hospital of Modena, Modena, Italy
| | - Paolo Nichelli
- Stroke Unit, Neurology Clinic, Department of Neuroscience, Nuovo Ospedale Civile S. Agostino-Estense, University Hospital of Modena, Modena, Italy
| | - Andrea Zini
- Stroke Unit, Neurology Clinic, Department of Neuroscience, Nuovo Ospedale Civile S. Agostino-Estense, University Hospital of Modena, Modena, Italy.
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The first six-month clinical outcomes and risk factors associated with high on-treatment platelet reactivity of clopidogrel in patients undergoing coronary interventions. Anatol J Cardiol 2016; 16:967-973. [PMID: 27271476 PMCID: PMC5324919 DOI: 10.14744/anatoljcardiol.2016.6855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE This study attempted to fill the gaps in evidence related to response to clopidogrel treatment in the Turkish population. The study aimed to determine the prevalence, associated risk factors, and clinical outcomes of high on-treatment platelet reactivity (HTPR) of clopidogrel in patients undergoing percutaneous coronary intervention (PCI) in a tertiary cardiovascular hospital in Turkey. METHODS In this prospective studied a total of 1.238 patients undergoing PCI were included in the present study. Blood samples were analyzed using a Multiplate analyzer. All patients were examined in the outpatient clinics at the end of the first and sixth months for recording drug therapy compliance and study endpoints. RESULTS Among the study population, 324 (30.2%) patients were found to have HTPR (mean age 58.03±11.88 years, 71.7% men). The incidence of HTPR was higher amongst females than amongst males (38.3% vs. 27%, p=0.010). Hypertension and diabetes mellitus were more frequently observed in the HTPR group (57.7% vs. 48.7%, p=0.004; 35% vs. 29.1%, p=0.040, respectively). When the recorded data were analyzed using multinomial regression analysis, hypertension, hemoglobin level, platelet, lymphocyte, and eosinophil count were independently associated with HTPR. CONCLUSION On the basis of the results obtained from our study, we conclude that 30.2% of the Turkish population has HTPR. Our results also led us to believe that hypertension is an associated risk factor and decreased hemoglobin level as well as increased platelet counts are laboratory parameters that are strongly associated with the presence of HTPR. However, no differences were observed with regard to cardiovascular mortality and stent thrombosis.
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Sakai N, Hori H, Yoshida Y, Konakahara T, Ogiwara Y. Copper(I)-catalyzed coupling reaction of aryl boronic acids with N,O-acetals and N,N-aminals under atmosphere leading to α-aryl glycine derivatives and diarylmethylamine derivatives. Tetrahedron 2015. [DOI: 10.1016/j.tet.2015.05.068] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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