|Pharmacogenetics of clopidogrel (polymorphism in the gene, CYP2C9)||Price 10 800 tenge|
The original clopidogrel: Plavix Generics: Aggregal, Detromb, Zilt, Clopidogrel, Listab 75, Lopirel, Plagril, Trocen, Etitromb Regulated doses of Clopidogrel:
- "Stable" patients: 75 mg once daily
- "Unstable" patients: 300 mg once a day once, then 75 mg once a day
|Problems when using Clopidogrel:||Associations between detectableidentified allelic variants ( The following is an example of this phenomenon: Carriers of CYP2C19*2 and CYP2C19*3 alleles have a weak antiplatelet effect of Clopidogrel due to impaired formation of its active metabolite in the liver, which leads to genetically determined resistance to this drug. The clinical implications of this phenomenon is that carriers of CYP2C19*2 and CYP2C19*3 alleles, receiving Clopidogrel, have a higher risk of cardiovascular events, compared with patients who do not carry these alleles [Gladding P 2008].|
Indications for pharmacogenetic testing for CYP2C19 to predict resistance to clopidogrel:
- CYP2C19 pharmacogenetic testing is not feasible in all patients receiving Clopidogrel (AHA 2011: Class III, level of evidence C).
- Situations in which pharmacogenetic testing for CYP2C19 is desirable (AHA 2011: Class IIb, level of evidence C. ESC 2011: Class IIb, level B):
- interventions on the unprotected LMCA trunk (AHA 2011),
- bifurcation stenosis of the LMCA trunk (AHA 2011),
- single coronary artery stenosis (AHA 2011),
- repeated PCIs (AHA 2011),
- history of stent thrombosis (CPIC 2011),
- high risk clinical factors (ACS, diabetes mellitus, chronic renal failure) (CPIC 2011).
Recommendations of the European Science Foundation (ESF), Recommendations ESH (2011) on management of ACS without elevation ST , Recommendations of the Pharmacogenetics Consortium (CPIC, USA), Recommendations AHA (American Heart Association, 2011).
Management tactics for detecting polymorphisms of the CYP2C19
- If CYP2C19*2 or CYP2C19*3 allelic variants are found, alternative antiaggregants may be chosen: Ticagrelor (Brilinta) or Prasugrel (Effient) (class IIb, level of evidence C)
- Increase the dose of Clopidogrel to 150-300 mg/day (maintenance)
- "Triple" antiplatelet therapy (ASA + Clopidogrel + Cilostazol)
- Adding omega3-polyunsaturated acids (Omacor) at a dose of 1000 mg/day to Clopidogrel
- Ticlopidine + Ginkgo (TIA, AI)
*Information prepared according to materials of Professor D.A. Sychev, M.D.