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2015 ; 54
(2
): 147-66
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Clinical pharmacokinetics and pharmacodynamics of clopidogrel
#MMPMID25559342
Jiang XL
; Samant S
; Lesko LJ
; Schmidt S
Clin Pharmacokinet
2015[Feb]; 54
(2
): 147-66
PMID25559342
show ga
Acute coronary syndromes (ACS) remain life-threatening disorders, which are
associated with high morbidity and mortality. Dual antiplatelet therapy with
aspirin and clopidogrel has been shown to reduce cardiovascular events in
patients with ACS. However, there is substantial inter-individual variability in
the response to clopidogrel treatment, in addition to prolonged recovery of
platelet reactivity as a result of irreversible binding to P2Y12 receptors. This
high inter-individual variability in treatment response has primarily been
associated with genetic polymorphisms in the genes encoding for cytochrome (CYP)
2C19, which affect the pharmacokinetics of clopidogrel. While the US Food and
Drug Administration has issued a boxed warning for CYP2C19 poor metabolizers
because of potentially reduced efficacy in these patients, results from
multivariate analyses suggest that additional factors, including age, sex,
obesity, concurrent diseases and drug-drug interactions, may all contribute to
the overall between-subject variability in treatment response. However, the
extent to which each of these factors contributes to the overall variability, and
how they are interrelated, is currently unclear. The objective of this review
article is to provide a comprehensive update on the different factors that
influence the pharmacokinetics and pharmacodynamics of clopidogrel and how they
mechanistically contribute to inter-individual differences in the response to
clopidogrel treatment.