Pharmacogenetics of Antiplatelet Therapy.

IF 11.2 1区 医学 Q1 PHARMACOLOGY & PHARMACY Annual review of pharmacology and toxicology Pub Date : 2023-01-20 Epub Date: 2022-01-08 DOI:10.1146/annurev-pharmtox-051921-092701
Matteo Castrichini, Jasmine A Luzum, Naveen Pereira
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Abstract

Antiplatelet therapy is used in the treatment of patients with acute coronary syndromes, stroke, and those undergoing percutaneous coronary intervention. Clopidogrel is the most widely used antiplatelet P2Y12 inhibitor in clinical practice. Genetic variation in CYP2C19 may influence its enzymatic activity, resulting in individuals who are carriers of loss-of-function CYP2C19 alleles and thus have reduced active clopidogrel metabolites, high on-treatment platelet reactivity, and increased ischemic risk. Prospective studies have examined the utility of CYP2C19 genetic testing to guide antiplatelet therapy, and more recently published meta-analyses suggest that pharmacogenetics represents a key treatment strategy to individualize antiplatelet therapy. Rapid genetic tests, including bedside genotyping platforms that are validated and have high reproducibility, are available to guide selection of P2Y12 inhibitors in clinical practice. The aim of this review is to provide an overview of the background and rationale for the role of a guided antiplatelet approach to enhance patient care.

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抗血小板疗法的药物遗传学。
抗血小板疗法用于治疗急性冠状动脉综合征、中风和接受经皮冠状动脉介入治疗的患者。氯吡格雷是临床上使用最广泛的抗血小板 P2Y12 抑制剂。CYP2C19 的基因变异可能会影响其酶活性,导致携带功能缺失 CYP2C19 等位基因的个体活性氯吡格雷代谢物减少,治疗时血小板反应性高,缺血风险增加。前瞻性研究探讨了 CYP2C19 基因检测对指导抗血小板治疗的作用,最近发表的荟萃分析表明,药物遗传学是抗血小板治疗个体化的关键治疗策略。快速基因检测,包括经过验证且重现性高的床旁基因分型平台,可用于指导临床实践中 P2Y12 抑制剂的选择。本综述旨在概述指导性抗血小板疗法在加强患者护理方面发挥作用的背景和原理。
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来源期刊
CiteScore
27.80
自引率
0.00%
发文量
53
期刊介绍: Since 1961, the Annual Review of Pharmacology and Toxicology has been a comprehensive resource covering significant developments in pharmacology and toxicology. The journal encompasses various aspects, including receptors, transporters, enzymes, chemical agents, drug development science, and systems like the immune, nervous, gastrointestinal, cardiovascular, endocrine, and pulmonary systems. Special topics are also featured in this annual review.
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