Division of Neurocritical Care and Emergency Neurology, Stroke Service, Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA.
Stroke. 2010 Dec;41(12):2997-3002. doi: 10.1161/STROKEAHA.110.594069. Epub 2010 Oct 28.
Clopidogrel is one of the most commonly prescribed medications worldwide. Recent advisories from the US Food and Drug Administration have drawn attention to the possibility of personalized decision-making for people 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 how the body handles 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 Food and Drug Administration advisories and conclude that genetic testing for CYP2C19 genotype and limitation of proton pump inhibitor interactions do not yet appear to offer an opportunity to optimize treatment given the current state of knowledge.
氯吡格雷是全球最常用的药物之一。最近美国食品和药物管理局发布的公告引起了人们对氯吡格雷候选人群进行个体化决策的关注。与降压药、他汀类药物和华法林一样，常见的遗传序列变异会影响氯吡格雷的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。同时使用的药物也会影响身体对氯吡格雷的处理方式。与氯吡格雷联合广泛使用的质子泵抑制剂可能会降低其疗效。我们根据积累的数据和当前美国食品和药物管理局的公告，讨论了对床边决策的影响，并得出结论，鉴于目前的知识水平，CYP2C19 基因型的基因检测和质子泵抑制剂相互作用的限制似乎还没有提供优化治疗的机会。
