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
-
Toward The Rational Design of Cell Fate Modifiers Notch Signaling as a Target for Novel Biopharmaceuticals
Current Pharmaceutical Biotechnology Multi-Target Drug Design Approaches for Multifactorial Diseases: From Neurodegenerative to Cardiovascular Applications
Current Medicinal Chemistry Targeting the Arrhythmogenic Substrate in Atrial Fibrillation: Focus on Structural Remodeling
Current Drug Targets Physiological and Molecular Role of Ranpirnase on Cancer Treatment
Current Cancer Therapy Reviews Protease-Activated Receptor 2: Are Common Functions in Glial and Immune Cells Linked to Inflammation-Related CNS Disorders?
Current Drug Targets Collagen Cross-link Breakers:A Beginning of a New Era in the Treatment of Cardiovascular Changes Associated with Aging,Diabetes,and Hypertension
Current Drug Targets - Cardiovascular & Hematological Disorders Role of Unani Polyherbal Formulations in the Treatment of Diseases with Special Reference to Neurodegenerative Disorders
CNS & Neurological Disorders - Drug Targets Skeletal Muscle Derived Stem Cells for Myocardial Repair
Recent Patents on Cardiovascular Drug Discovery Histone Deacetylase Inhibitors: From Chromatin Remodeling to Experimental Cancer Therapeutics
Current Medicinal Chemistry Macrophages in Immunopathology of Atherosclerosis: A Target for Diagnostics and Therapy
Current Pharmaceutical Design Dural Venous Sinuses: What We Need to Know
Current Medical Imaging Glucose Lowering Activity of Anvillea Radiata Coss & Durieu in Diabetic Rats
Cardiovascular & Hematological Disorders-Drug Targets A New Battlefield Towards Global Health in 21<sup>st</sup> Century: Clinical Research Networks
Applied Clinical Research, Clinical Trials and Regulatory Affairs Higher Anti-angiogenesis Activity, Better Cellular Uptake and Longer Half-life of a Novel Glyco-modified Endostatin by Polysulfated Heparin
Current Pharmaceutical Biotechnology Preface [Hot Topic: Treatment of Hypertension, Its Pathophysiology and the Clinical Use of Antihypertensive Drugs (Executive Editor: Gregory Y.H. Lip)]
Current Pharmaceutical Design Hypoxic Gas Therapy in Neonatology: Considerations in Practice
Current Drug Discovery Technologies Bone Mineral Density in Type 2 Diabetes Patients with Charcot Arthropathy
Current Diabetes Reviews Recent Advancements in Identification of Novel Drug Targets and Drug Delivery for Cardiovascular and Hematological Disorders
Cardiovascular & Hematological Disorders-Drug Targets Catestatin - The Catecholamine Release Inhibitory Peptide: A Structural and Functional Overview
Current Medicinal Chemistry - Immunology, Endocrine & Metabolic Agents Transport of Cryptotanshinone, a Major Active Triterpenoid in Salvia Miltiorrhiza Bunge Widely Used in the Treatment of Stroke and Alzheimers Disease, Across the Blood-Brain Barrier
Current Drug Metabolism