Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands.
Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA.
J Am Coll Cardiol. 2024 Sep 17;84(12):1107-1118. doi: 10.1016/j.jacc.2024.06.038.
The clinical efficacy and safety of antiplatelet agents vary among patients. Consequently, some patients are at increased risk of recurrent ischemic events during treatment. This interindividual variability can be a result of genetic variants in enzymes that play a role in drug metabolism. The field of pharmacogenomics explores the influence of these genetic variants on an individual's drug response. Tailoring antiplatelet treatment based on genetic variants can potentially result in optimized dosing or a change in drug selection. Most evidence supports guiding therapy based on the CYP2C19 allelic variants in patients with an indication for dual antiplatelet therapy. In ticagrelor-treated or prasugrel-treated patients, a genotype-guided de-escalation strategy can reduce bleeding risk, whereas in patients treated with clopidogrel, an escalation strategy may prevent ischemic events. Although the clinical results are promising, few hospitals have implemented these strategies. New results, technological advancements, and growing experience may potentially overcome current barriers for implementation in the future.
抗血小板药物在患者中的临床疗效和安全性存在差异。因此，一些患者在治疗过程中复发缺血事件的风险增加。这种个体间的变异性可能是药物代谢中起作用的酶的遗传变异的结果。药物基因组学领域探讨了这些遗传变异对个体药物反应的影响。根据遗传变异来调整抗血小板治疗可能会导致优化剂量或改变药物选择。大多数证据支持基于双重抗血小板治疗适应证患者 CYP2C19 等位基因变异来指导治疗。在接受替格瑞洛或普拉格雷治疗的患者中，基因型指导的降级策略可以降低出血风险，而在接受氯吡格雷治疗的患者中，升级策略可能预防缺血事件。尽管临床结果很有前景，但很少有医院实施这些策略。新的结果、技术进步和不断增加的经验可能会在未来克服实施的当前障碍。
