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Piano M, Lozupone E, Milonia L, Pero G, Cervo A, Macera A, Quilici L, Visconti E, Valvassori L, Cenzato M, Boccardi E. Flow diverter devices in the treatment of complex middle cerebral artery aneurysms when surgical and endovascular treatments are challenging. J Stroke Cerebrovasc Dis 2022; 31:106760. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/17/2022] [Accepted: 09/04/2022] [Indexed: 11/21/2022] Open
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2
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Lim IH, Lee SJ, Shin BS, Kang HG. Ilaprazole and Clopidogrel Resistance in Acute Stroke Patients. Biomedicines 2022; 10:biomedicines10061366. [PMID: 35740386 PMCID: PMC9219695 DOI: 10.3390/biomedicines10061366] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 01/01/2023] Open
Abstract
Clopidogrel, an antiplatelet agent used for secondary prevention of cerebrovascular diseases, is often taken with proton pump inhibitors (PPIs). Generally, the combined use of clopidogrel and PPIs causes adverse drug–drug interactions. VerifyNow is a quick and convenient method to confirm clopidogrel resistance (CR), which compromises adequate antithrombotic effects. We aimed to confirm CR, identify its factors, and determine the influence of the combination of ilaprazole and clopidogrel on clopidogrel using VerifyNow. In this retrospective study, we examined patients who were receiving clopidogrel after three months, starting within one week from the onset of cerebral infarction symptoms. Clinical records, imaging records, and diagnostic laboratory results, including P2Y12 reaction units (PRU), were compared and analyzed to check for CR. Additionally, the groups treated with either both ilaprazole and clopidogrel or with medications other than ilaprazole were comparatively analyzed. CR was defined as a PRU ≥240 after clopidogrel for three months. Among factors influencing CR by affecting clopidogrel metabolism, positive statistical correlations with age and alcohol consumption were confirmed. The diagnostic tests revealed a lower glomerular filtration rate and platelet count of the CR-positive group. This finding proved that the combination therapy of ilaprazole and clopidogrel is safe, as it does not interfere with the metabolism of clopidogrel.
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Affiliation(s)
- In Hwan Lim
- Department of Pharmacology, School of Medicine, Wonkwang University, Iksan 54538, Korea;
| | - Seung Jae Lee
- Department of Chemistry, Institute for Molecular Biology and Genetics, Jeonbuk National University, Jeonju 54907, Korea;
| | - Byoung-Soo Shin
- Department of Neurology, Jeonbuk National University, Jeonju 54907, Korea;
- Research Institute of Clinical Medicine, Jeonbuk National University, Jeonju 54907, Korea
- Biomedical Research Institute, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Korea
| | - Hyun Goo Kang
- Department of Neurology, Jeonbuk National University, Jeonju 54907, Korea;
- Research Institute of Clinical Medicine, Jeonbuk National University, Jeonju 54907, Korea
- Biomedical Research Institute, Jeonbuk National University Medical School and Hospital, Jeonju 54907, Korea
- Correspondence: ; Tel.: +82-63-250-1590
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3
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Wu H, Li X, Qian J, Zhao X, Yao Y, Lv Q, Ge J. Development and Validation of a Novel Tool for the Prediction of Clopidogrel Response in Chinese Acute Coronary Syndrome Patients: The GeneFA Score. Front Pharmacol 2022; 13:854867. [PMID: 35387342 PMCID: PMC8977638 DOI: 10.3389/fphar.2022.854867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
Aim: Growing evidence indicated that CYP2C19 genotypes could only explain a fraction of the pharmacodynamic response to clopidogrel, while a number of clinical factors also have contributing roles. Our objective was to develop a new risk score to improve prognostication of ischemic events in Chinese patients treated with clopidogrel. Methods: A new risk score was developed and internally validated in 445 patients with acute coronary syndrome (ACS) undergoing coronary stenting. The final score was named the GeneFA score based on the inclusion of CYP2C19 genotype, fibrinogen, and age. External validation of the GeneFA score and comparison with the ABCD-GENE score were performed in an independent ACS cohort. Results: Based on the observed frequencies of high platelet reactivity (HRPR) in relation to the GeneFA risk score, a relatively higher clinical HRPR was observed in the upper quintile with a representative score of 3 (52.90%) and 4 (59.10%), whereas it was found less frequently in groups with scores 0 (6.70%), 1 (15.10%), and 2 (16.70%). Participants with a GeneFA score >2 had an increased risk of HRPR (54.3 vs. 14.7%, p < 0.001) and ischemic recurrence (20.7 vs. 5.4%, p < 0.001). The GeneFA score exhibited a better prediction for high HRPR patients as compared to the ABCD-GENE score (p < 0.001). In the validation population, GeneFA illustrated a similarly high prognostic value for HRPR incidence (C-statistic: 0.855 for GeneFA and 0.843 for ABCD-GENE) and ischemic recurrence (C-statistic: 0.726 for GeneFA and 0.724 for ABCD-GENE) on clopidogrel as compared to ABCD-GENE. Conclusion: The GeneFA risk score had a moderate predictive ability for HRPR on clopidogrel for CAD patients in Chinese populations. The predictive value of the GeneFA score was consistent with the ABCD-GENE score for HRPR identification.
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Affiliation(s)
- Hongyi Wu
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xiaoye Li
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xin Zhao
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yao Yao
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qianzhou Lv
- Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.,National Clinical Research Center for Interventional Medicine, Shanghai, China
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Hirata TDC, Dagli-Hernandez C, Genvigir FDV, Lauschke VM, Zhou Y, Hirata MH, Hirata RDC. Cardiovascular Pharmacogenomics: An Update on Clinical Studies of Antithrombotic Drugs in Brazilian Patients. Mol Diagn Ther 2021; 25:735-755. [PMID: 34357562 DOI: 10.1007/s40291-021-00549-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
Anticoagulant and antiplatelet drugs effectively prevent thrombotic events in patients with cardiovascular diseases, ischemic stroke, peripheral vascular diseases, and other thromboembolic diseases. However, genetic and non-genetic factors affect the response to antithrombotic therapy and can increase the risk of adverse events. This narrative review discusses pharmacogenomic studies on antithrombotic drugs commonly prescribed in Brazil. Multiple Brazilian studies assessed the impact of pharmacokinetic (PK) and pharmacodynamic (PD) gene variants on warfarin response. The reduced function alleles CYP2C9*2 and CYP2C9*3, and VKORC1 rs9923231 (c.-1639G>A) are associated with increased sensitivity to warfarin and a low dose requirement to prevent bleeding episodes, whereas CYP4F2 rs2108622 (p.Val433Met) carriers have higher dose requirements (warfarin resistance). These deleterious variants and non-genetic factors (age, gender, body weight, co-administered drugs, food interactions, and others) account for up to 63% of the warfarin dose variability. Few pharmacogenomics studies have explored antiplatelet drugs in Brazilian cohorts, finding associations between CYP2C19*2, PON1 rs662 and ABCC3 rs757421 genotypes and platelet responsiveness or clopidogrel PK in subjects with coronary artery disease (CAD) or acute coronary syndrome (ACS), whereas ITGB3 contributes to aspirin PK but not platelet responsiveness in diabetic patients. Brazilian guidelines on anticoagulants and antiplatelets recommend the use of a platelet aggregation test or genotyping only in selected cases of ACS subjects without ST-segment elevation taking clopidogrel, and also suggest CYP2C9 and VKORC1 genotyping before starting warfarin therapy to assess the risk of bleeding episodes or warfarin resistance.
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Affiliation(s)
- Thiago Dominguez Crespo Hirata
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Av. Prof. Lineu Prestes 580, Sao Paulo, 05508-000, Brazil
| | - Carolina Dagli-Hernandez
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Av. Prof. Lineu Prestes 580, Sao Paulo, 05508-000, Brazil
| | - Fabiana Dalla Vecchia Genvigir
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Av. Prof. Lineu Prestes 580, Sao Paulo, 05508-000, Brazil
| | - Volker Martin Lauschke
- Department of Physiology and Pharmacology, Karolinska Institutet, 171 77, Solna, Sweden.,Dr Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, 70376, Germany
| | - Yitian Zhou
- Department of Physiology and Pharmacology, Karolinska Institutet, 171 77, Solna, Sweden
| | - Mario Hiroyuki Hirata
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Av. Prof. Lineu Prestes 580, Sao Paulo, 05508-000, Brazil
| | - Rosario Dominguez Crespo Hirata
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of Sao Paulo, Av. Prof. Lineu Prestes 580, Sao Paulo, 05508-000, Brazil.
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Jeiziner C, Suter K, Wernli U, Barbarino JM, Gong L, Whirl-Carrillo M, Klein TE, Szucs TD, Hersberger KE, Meyer zu Schwabedissen HE. Pharmacogenetic information in Swiss drug labels - a systematic analysis. THE PHARMACOGENOMICS JOURNAL 2021; 21:423-434. [PMID: 33070160 PMCID: PMC8292148 DOI: 10.1038/s41397-020-00195-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/18/2020] [Accepted: 10/05/2020] [Indexed: 01/31/2023]
Abstract
Implementation of pharmacogenetics (PGx) and individualization of drug therapy is supposed to obviate adverse drug reactions or therapy failure. Health care professionals (HCPs) use drug labels (DLs) as reliable information about drugs. We analyzed the Swiss DLs to give an overview on the currently available PGx instructions. We screened 4306 DLs applying natural language processing focusing on drug metabolism (pharmacokinetics) and we assigned PGx levels following the classification system of PharmGKB. From 5979 hits, 2564 were classified as PGx-relevant affecting 167 substances. 55% (n = 93) were classified as "actionable PGx". Frequently, PGx information appeared in the pharmacokinetics section and in DLs of the anatomic group "nervous system". Unstandardized wording, appearance of PGx information in different sections and unclear instructions challenge HCPs to identify and interpret PGx information and translate it into practice. HCPs need harmonization and standardization of PGx information in DLs to personalize drug therapies and tailor pharmaceutical care.
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Affiliation(s)
- C. Jeiziner
- grid.6612.30000 0004 1937 0642Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Basel, 4001 Switzerland
| | - K. Suter
- grid.6612.30000 0004 1937 0642European Center of Pharmaceutical Medicine, Faculty of Medicine, University of Basel, Basel, 4056 Switzerland
| | - U. Wernli
- grid.6612.30000 0004 1937 0642Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Basel, 4001 Switzerland
| | - J. M. Barbarino
- grid.168010.e0000000419368956Department of Biomedical Data Sciences, Stanford University, Stanford, CA 94305 USA
| | - L. Gong
- grid.168010.e0000000419368956Department of Biomedical Data Sciences, Stanford University, Stanford, CA 94305 USA
| | - M. Whirl-Carrillo
- grid.168010.e0000000419368956Department of Biomedical Data Sciences, Stanford University, Stanford, CA 94305 USA
| | - T. E. Klein
- grid.168010.e0000000419368956Department of Biomedical Data Sciences, Stanford University, Stanford, CA 94305 USA ,grid.168010.e0000000419368956Department of Medicine, Stanford University, Stanford, CA 94305 USA
| | - T. D. Szucs
- grid.6612.30000 0004 1937 0642European Center of Pharmaceutical Medicine, Faculty of Medicine, University of Basel, Basel, 4056 Switzerland
| | - K. E. Hersberger
- grid.6612.30000 0004 1937 0642Pharmaceutical Care Research Group, Department of Pharmaceutical Sciences, University of Basel, Basel, 4001 Switzerland
| | - H. E. Meyer zu Schwabedissen
- grid.6612.30000 0004 1937 0642Biopharmacy, Department of Pharmaceutical Sciences, University of Basel, Basel, 4056 Switzerland
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6
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Abstract
Abstract
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Affiliation(s)
- Jean-Sébastien Hulot
- Centre d’Investigations Cliniques CIC1418, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
- Université de Paris, Paris Cardiovascular Research Center PARCC, INSERM, Paris, France
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, INSERM UMRS_1166, Institut de cardiologie (AP-HP), Paris, France
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7
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Ufer M, Huynh C, van Lier JJ, Caroff E, Fischer H, Dingemanse J. Absorption, distribution, metabolism and excretion of the P2Y12 receptor antagonist selatogrel after subcutaneous administration in healthy subjects. Xenobiotica 2019; 50:427-434. [DOI: 10.1080/00498254.2019.1646440] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Mike Ufer
- Department of Clinical Pharmacology, Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Christine Huynh
- Department of Clinical Pharmacology, Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
| | | | - Eva Caroff
- Department of Clinical Pharmacology, Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
| | - Hartmut Fischer
- A&M Labor für Analytik und Metabolismusforschung Service GmbH, Bergheim, Germany
| | - Jasper Dingemanse
- Department of Clinical Pharmacology, Idorsia Pharmaceuticals Ltd, Allschwil, Switzerland
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8
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Caroff E, Hubler F, Meyer E, Renneberg D, Gnerre C, Treiber A, Rey M, Hess P, Steiner B, Hilpert K, Riederer MA. 4-((R)-2-{[6-((S)-3-Methoxypyrrolidin-1-yl)-2-phenylpyrimidine-4-carbonyl]amino}-3-phosphonopropionyl)piperazine-1-carboxylic Acid Butyl Ester (ACT-246475) and Its Prodrug (ACT-281959), a Novel P2Y12 Receptor Antagonist with a Wider Therapeutic Window in the Rat Than Clopidogrel. J Med Chem 2015; 58:9133-53. [DOI: 10.1021/acs.jmedchem.5b00933] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Eva Caroff
- Drug Discovery and Preclinical
Research and Development, Actelion Pharmaceuticals Ltd., Gewerbestrasse
16, CH-4123 Allschwil, Switzerland
| | - Francis Hubler
- Drug Discovery and Preclinical
Research and Development, Actelion Pharmaceuticals Ltd., Gewerbestrasse
16, CH-4123 Allschwil, Switzerland
| | - Emmanuel Meyer
- Drug Discovery and Preclinical
Research and Development, Actelion Pharmaceuticals Ltd., Gewerbestrasse
16, CH-4123 Allschwil, Switzerland
| | - Dorte Renneberg
- Drug Discovery and Preclinical
Research and Development, Actelion Pharmaceuticals Ltd., Gewerbestrasse
16, CH-4123 Allschwil, Switzerland
| | - Carmela Gnerre
- Drug Discovery and Preclinical
Research and Development, Actelion Pharmaceuticals Ltd., Gewerbestrasse
16, CH-4123 Allschwil, Switzerland
| | - Alexander Treiber
- Drug Discovery and Preclinical
Research and Development, Actelion Pharmaceuticals Ltd., Gewerbestrasse
16, CH-4123 Allschwil, Switzerland
| | - Markus Rey
- Drug Discovery and Preclinical
Research and Development, Actelion Pharmaceuticals Ltd., Gewerbestrasse
16, CH-4123 Allschwil, Switzerland
| | - Patrick Hess
- Drug Discovery and Preclinical
Research and Development, Actelion Pharmaceuticals Ltd., Gewerbestrasse
16, CH-4123 Allschwil, Switzerland
| | - Beat Steiner
- Drug Discovery and Preclinical
Research and Development, Actelion Pharmaceuticals Ltd., Gewerbestrasse
16, CH-4123 Allschwil, Switzerland
| | - Kurt Hilpert
- Drug Discovery and Preclinical
Research and Development, Actelion Pharmaceuticals Ltd., Gewerbestrasse
16, CH-4123 Allschwil, Switzerland
| | - Markus A. Riederer
- Drug Discovery and Preclinical
Research and Development, Actelion Pharmaceuticals Ltd., Gewerbestrasse
16, CH-4123 Allschwil, Switzerland
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9
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Sabouret P, Rushton-Smith SK, Kerneis M, Silvain J, Collet JP, Montalescot G. Dual antiplatelet therapy: optimal timing, management, and duration. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2015; 1:198-204. [PMID: 27533996 DOI: 10.1093/ehjcvp/pvv015] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 03/18/2015] [Indexed: 12/27/2022]
Abstract
Platelet activation and aggregability play a key role in the genesis of arterial thrombus secondary to plaque rupture. For coronary patients, inhibition of platelet function is crucial to decrease the rate of major adverse cardiac events but may expose them to excess bleeding risk. Switching P2Y12 inhibitors is common, yet the clinical consequences are unknown. The aim of this review is to provide an overview of the evidence from randomized, clinical trials and epidemiological studies, with a focus on the optimal duration of dual antiplatelet therapy (DAPT) and appropriate agent and dose selection. The report discusses the latest evidence regarding switching therapies during DAPT, the potential benefits of a personalized strategy, management of the preoperative period, and other clinical perspectives in this complex and rapidly changing field. Ongoing trials will be useful to answer to some important unresolved questions.
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Affiliation(s)
- Pierre Sabouret
- Institut du Cœur, Pitié-Salpêtrière Hospital (AP-HP), Pierre and Marie Curie University, 47-83, boulevard de l'Hôpital, Paris 75013, France, ACTION Group, www.action-coeur.org
| | | | - Mathieu Kerneis
- Institut du Cœur, Pitié-Salpêtrière Hospital (AP-HP), Pierre and Marie Curie University, 47-83, boulevard de l'Hôpital, Paris 75013, France, ACTION Group, www.action-coeur.org
| | - Johanne Silvain
- Institut du Cœur, Pitié-Salpêtrière Hospital (AP-HP), Pierre and Marie Curie University, 47-83, boulevard de l'Hôpital, Paris 75013, France, ACTION Group, www.action-coeur.org
| | - Jean-Philippe Collet
- Institut du Cœur, Pitié-Salpêtrière Hospital (AP-HP), Pierre and Marie Curie University, 47-83, boulevard de l'Hôpital, Paris 75013, France, ACTION Group, www.action-coeur.org
| | - Gilles Montalescot
- Institut du Cœur, Pitié-Salpêtrière Hospital (AP-HP), Pierre and Marie Curie University, 47-83, boulevard de l'Hôpital, Paris 75013, France, ACTION Group, www.action-coeur.org
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10
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Beitelshees AL, Voora D, Lewis JP. Personalized antiplatelet and anticoagulation therapy: applications and significance of pharmacogenomics. Pharmgenomics Pers Med 2015; 8:43-61. [PMID: 25897256 PMCID: PMC4397717 DOI: 10.2147/pgpm.s52900] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
In recent years, substantial effort has been made to better understand the influence of genetic factors on the efficacy and safety of numerous medications. These investigations suggest that the use of pharmacogenetic data to inform physician decision-making has great potential to enhance patient care by reducing on-treatment clinical events, adverse drug reactions, and health care-related costs. In fact, integration of such information into the clinical setting may be particularly applicable for antiplatelet and anticoagulation therapeutics, given the increasing body of evidence implicating genetic variation in variable drug response. In this review, we summarize currently available pharmacogenetic information for the most commonly used antiplatelet (ie, clopidogrel and aspirin) and anticoagulation (ie, warfarin) medications. Furthermore, we highlight the currently known role of genetic variability in response to next-generation antiplatelet (prasugrel and ticagrelor) and anticoagulant (dabigatran) agents. While compelling evidence suggests that genetic variants are important determinants of antiplatelet and anticoagulation therapy response, significant barriers to clinical implementation of pharmacogenetic testing exist and are described herein. In addition, we briefly discuss development of new diagnostic targets and therapeutic strategies as well as implications for enhanced patient care. In conclusion, pharmacogenetic testing can provide important information to assist clinicians with prescribing the most personalized and effective antiplatelet and anticoagulation therapy. However, several factors may limit its usefulness and should be considered.
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Affiliation(s)
- Amber L Beitelshees
- Program for Personalized and Genomic Medicine and Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Deepak Voora
- Center for Applied Genomics & Precision Medicine, Department of Medicine, Duke School of Medicine, Durham, NC, USA
| | - Joshua P Lewis
- Program for Personalized and Genomic Medicine and Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore, MD, USA
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11
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New antiplatelet agents in the treatment of acute coronary syndromes. Arch Cardiovasc Dis 2014; 107:178-87. [PMID: 24630752 DOI: 10.1016/j.acvd.2014.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Accepted: 01/13/2014] [Indexed: 11/23/2022]
Abstract
Effective antagonism of the P2Y12 platelet receptor is central to the treatment of acute coronary syndrome (ACS) patients, especially in the setting of percutaneous coronary intervention and stenting. According to consensus guidelines, early revascularization and intensive antiplatelet therapy are key to reducing the complications that arise from myocardial ischaemia and the recurrence of cardiovascular events. Until recently, clopidogrel was the key P2Y12 antagonist advocated, but due to several limitations as an antiplatelet agent, newer drugs with more predictable, rapid and potent effects have been developed. Prasugrel and ticagrelor are now the recommended first-line agents in patients presenting with non-ST-segment elevation ACS and ST-segment elevation ACS, due to large-scale randomized trials that demonstrated net clinical benefit of these agents over clopidogrel, as stated in the European guidelines. Although no study has directly compared the two agents, analysis of the data to date suggests that certain patient types, such as diabetics, those with ST-segment elevation myocardial infarction or renal failure and the elderly may have a better outcome with one agent over the other. Further studies are needed to confirm these differences and answer pending questions regarding the use of these drugs to optimize efficacy while minimizing adverse events, such as bleeding. The aim of this review is to provide an overview of the current P2Y12 receptor antagonists in the treatment of ACS, with a focus on issues of appropriate agent selection, timing of treatment, bleeding risk and the future role of personalized treatment using platelet function and genetic testing.
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12
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Current practice on the management of acute coronary syndrome in China. Int J Cardiol 2013; 169:1-6. [DOI: 10.1016/j.ijcard.2013.08.117] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 08/29/2013] [Indexed: 11/18/2022]
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