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药物遗传学在抗血栓治疗管理中的作用:新成就与尚待克服的障碍

The Role of Pharmacogenetics in Antithrombotic Therapy Management: New Achievements and Barriers Yet to Overcome.

作者信息

Conti Valeria, Corbi Graziamaria, Manzo Valentina, Sellitto Carmine, Iannello Francesco, Esposito Simone, De Bellis Emanuela, Iannaccone Teresa, Filippelli Amelia

机构信息

Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy.

Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy.

出版信息

Curr Med Chem. 2021;28(32):6675-6703. doi: 10.2174/0929867328666201231124715.

Abstract

BACKGROUND

Pharmacogenetics investigates the response to pharmacological treatments based on individual genetic background. Actually, numerous pharmacogenetic tests help to predict the response to drugs used in different medical areas, contributing to the so-called personalized medicine.

OBJECTIVE

This review aims to update the available data on the genotype-guided treatment with both the anticoagulant and antiplatelet agents. Moreover, it sheds light on the pitfalls in the implementation of cardiovascular pharmacogenetics.

METHODS

A review of the literature on the studies investigating the effects of the genotype- guided anticoagulant and antiplatelet treatment was performed.

RESULTS

Considering the extensive use of antithrombotic drugs, pharmacogenetics has particular importance in this field. Several polymorphisms influence the response to both anticoagulant and antiplatelet agents, and tests, based on their identification, are now available.

CONCLUSION

Recent randomized clinical trials demonstrated that pharmacogenetics might successfully contribute to optimizing the antiplatelet therapy also in patients particularly complicated to treat. However, despite accumulating evidence on the utility and feasibility of some pharmacogenetics tests, several barriers still exist in their implementation in clinical practice.

摘要

背景

药物遗传学基于个体遗传背景研究对药物治疗的反应。实际上,众多药物遗传学检测有助于预测不同医学领域所用药物的反应,推动了所谓的个性化医疗。

目的

本综述旨在更新关于抗凝剂和抗血小板药物基因型指导治疗的现有数据。此外,阐明心血管药物遗传学实施中的陷阱。

方法

对研究基因型指导抗凝和抗血小板治疗效果的文献进行综述。

结果

鉴于抗血栓药物的广泛使用,药物遗传学在该领域尤为重要。多种多态性影响对抗凝剂和抗血小板药物的反应,基于这些多态性识别的检测现已可用。

结论

近期随机临床试验表明,药物遗传学可能成功有助于优化抗血小板治疗,即使在治疗特别复杂的患者中也是如此。然而,尽管关于某些药物遗传学检测的效用和可行性的证据不断积累,但在临床实践中实施这些检测仍存在若干障碍。

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