Abstract
Dual antiplatelet therapy of clopidogrel added aspirin is an established treatment strategy to prevent recurrent ischemic event occurrence in coronary artery disease patients. Generally, a one size fits all nonselective strategy is used without an assessment of pharmacodynamic efficacy of clopidogrel therapy. However, pharmacodynamic studies revealed various limitations of clopidogrel metabolism and numerous factors such as genetic and, drug-drug interactions influence the antiplatelet response to clopidogrel therapy. Translational platelet function investigations performed in the percutaneous coronary intervention (PCI)-treated population receiving clopidogrel have identified high platelet reactivity (HPR) to adenosine diphosphate as a major risk factor for both acute as well as long-term ischemic event occurrence, including stent thrombosis. Recent studies have highlighted the relation of single nucleotide polymorphisms of genes involved in clopidogrel absorption and metabolism to reduced pharmacokinetic and pharmacodynamic responses to clopidogrel. Cytochrome (CYP) 2C19 loss-of-function (LoF) allele carriage has been associated with increased thrombotic risk in the PCI population. However, clopidogrel is pharmacodynamically effective in about two thirds of patients undergoing PCI; these patients do not have HPR. Therefore, selectively treating two thirds of patients with generic clopidogrel may provide significant cost savings. Unselected therapy with the new P2Y12 receptor blockers is associated with increased bleeding. The introduction of generic clopidogrel holds the strong possibility of inducing a change in practice whereby genetic and platelet function testing are performed more frequently in patients receiving a stent.
Keywords: Antiplatelet therapy, coronary artery disease, P2Y12 receptor blockers, clopidogrel, prasugrel, ticagrelor, Loss-of-function allele.
Current Pharmaceutical Design
Title:Antiplatelet Drug Resistance and Variability in Response: The Role of Antiplatelet Therapy Monitoring
Volume: 19 Issue: 21
Author(s): Udaya S. Tantry and Paul A. Gurbel
Affiliation:
Keywords: Antiplatelet therapy, coronary artery disease, P2Y12 receptor blockers, clopidogrel, prasugrel, ticagrelor, Loss-of-function allele.
Abstract: Dual antiplatelet therapy of clopidogrel added aspirin is an established treatment strategy to prevent recurrent ischemic event occurrence in coronary artery disease patients. Generally, a one size fits all nonselective strategy is used without an assessment of pharmacodynamic efficacy of clopidogrel therapy. However, pharmacodynamic studies revealed various limitations of clopidogrel metabolism and numerous factors such as genetic and, drug-drug interactions influence the antiplatelet response to clopidogrel therapy. Translational platelet function investigations performed in the percutaneous coronary intervention (PCI)-treated population receiving clopidogrel have identified high platelet reactivity (HPR) to adenosine diphosphate as a major risk factor for both acute as well as long-term ischemic event occurrence, including stent thrombosis. Recent studies have highlighted the relation of single nucleotide polymorphisms of genes involved in clopidogrel absorption and metabolism to reduced pharmacokinetic and pharmacodynamic responses to clopidogrel. Cytochrome (CYP) 2C19 loss-of-function (LoF) allele carriage has been associated with increased thrombotic risk in the PCI population. However, clopidogrel is pharmacodynamically effective in about two thirds of patients undergoing PCI; these patients do not have HPR. Therefore, selectively treating two thirds of patients with generic clopidogrel may provide significant cost savings. Unselected therapy with the new P2Y12 receptor blockers is associated with increased bleeding. The introduction of generic clopidogrel holds the strong possibility of inducing a change in practice whereby genetic and platelet function testing are performed more frequently in patients receiving a stent.
Export Options
About this article
Cite this article as:
S. Tantry Udaya and A. Gurbel Paul, Antiplatelet Drug Resistance and Variability in Response: The Role of Antiplatelet Therapy Monitoring, Current Pharmaceutical Design 2013; 19 (21) . https://dx.doi.org/10.2174/1381612811319210006
DOI https://dx.doi.org/10.2174/1381612811319210006 |
Print ISSN 1381-6128 |
Publisher Name Bentham Science Publisher |
Online ISSN 1873-4286 |
Call for Papers in Thematic Issues
"Tuberculosis Prevention, Diagnosis and Drug Discovery"
The Nobel Prize-winning discoveries of Mycobacterium tuberculosis and streptomycin have enabled an appropriate diagnosis and an effective treatment of tuberculosis (TB). Since then, many newer diagnosis methods and drugs have been saving millions of lives. Despite advances in the past, TB is still a leading cause of infectious disease mortality ...read more
Current Pharmaceutical challenges in the treatment and diagnosis of neurological dysfunctions
Neurological dysfunctions (MND, ALS, MS, PD, AD, HD, ALS, Autism, OCD etc..) present significant challenges in both diagnosis and treatment, often necessitating innovative approaches and therapeutic interventions. This thematic issue aims to explore the current pharmaceutical landscape surrounding neurological disorders, shedding light on the challenges faced by researchers, clinicians, and ...read more
Emerging and re-emerging diseases
Faced with a possible endemic situation of COVID-19, the world has experienced two important phenomena, the emergence of new infectious diseases and/or the resurgence of previously eradicated infectious diseases. Furthermore, the geographic distribution of such diseases has also undergone changes. This context, in turn, may have a strong relationship with ...read more
Melanoma and Non-Melanoma Skin Cancer Treatment: Standard of Care and Recent Advances
In this thematic issue, we aim to provide a standard of care of the diagnosis and treatment of melanoma and non-melanoma skin cancer. The editor will invite authors from different countries who will write review articles of melanoma and non-melanoma skin cancers. The Diagnosis, Staging, Surgical Treatment, Non-Surgical Treatment all ...read more
- Author Guidelines
- Graphical Abstracts
- Fabricating and Stating False Information
- Research Misconduct
- Post Publication Discussions and Corrections
- Publishing Ethics and Rectitude
- Increase Visibility of Your Article
- Archiving Policies
- Peer Review Workflow
- Order Your Article Before Print
- Promote Your Article
- Manuscript Transfer Facility
- Editorial Policies
- Allegations from Whistleblowers
- Announcements
Related Articles
-
Metabolic Syndrome: Clinical Features Leading to Therapeutic Strategies
Vascular Disease Prevention (Discontinued) Antihypertensive Drug Treatment and Circadian Blood Pressure Rhythm: A Review of the Role of Chronotherapy in Hypertension
Current Pharmaceutical Design Safety and Efficacy of Tirofiban as an Adjunctive Therapy for Patients with St-Elevation Myocardial Infarction: A Comparison Versus Placebo and Abciximab
Cardiovascular & Hematological Agents in Medicinal Chemistry Therapeutic Applications of Human Heme Oxygenase Gene Transfer and Gene Therapy
Current Pharmaceutical Design Aldosterone, Mineralocorticoid Receptor and the Metabolic Syndrome:Role of the Mineralocorticoid Receptor Antagonists
Current Vascular Pharmacology Start Small and Stay Small: Minimizing Attrition in the Clinic with a Focus on CNS Therapeutics
Current Topics in Medicinal Chemistry Heart Transplantation in Biventricular Congenital Heart Disease: Indications, Techniques, and Outcomes
Current Cardiology Reviews Imaging of Organ Metabolism in Obesity and Diabetes: Treatment Perspectives
Current Pharmaceutical Design Migraine: Current Therapeutic Targets and Future Avenues
Current Vascular Pharmacology Experimental Model Considerations for the Study of Protein-Energy Malnutrition Co-Existing with Ischemic Brain Injury
Current Neurovascular Research The Problem of Atrial Fibrillation in Patients with Chronic Kidney Disease
Current Vascular Pharmacology Benefit of SERCA2a Gene Transfer to Vascular Endothelial and Smooth Muscle Cells: A New Aspect in Therapy of Cardiovascular Diseases
Current Vascular Pharmacology Estrogen, Neuroprotection and Neurogenesis after Ischemic Stroke
Current Drug Targets Current Clinical Applications of Botulinum Toxin
Current Pharmaceutical Design A DNA Repair Pathway Polymorphism (rs25487) and Angiographically Proven Coronary Artery Patients in a Population of Southern Iran
Cardiovascular & Hematological Agents in Medicinal Chemistry Analysis of Prognostic Risk Factors for Ischemic Stroke in China: A Multicentre Retrospective Clinical Study; A National Survey in China
Current Neurovascular Research Neurophysiology of Sleep and Wakefulness: Basic Science and Clinical Implications
Current Neuropharmacology A New Metabotropic Role for L-type Ca2+ Channels in Vascular Smooth Muscle Contraction
Current Vascular Pharmacology Nomogram to Predict Symptomatic Intracranial Hemorrhage after Intravenous Thrombolysis in Acute Ischemic Stroke in Asian Population
Current Neurovascular Research Role of Citicoline in Promoting the Repair of Acute Peripheral Nerve Injury in Rat Models
Neuroscience and Biomedical Engineering (Discontinued)