The clopidogrel story: a cautionary tale of pharmacogenomics and personalized medicine
DOI:
https://doi.org/10.59736/IJP.23.02.962Keywords:
Clopidogrel, Clopidogrel Resistance, Pharmacogenetics, Personalized MedicineAbstract
Clopidogrel, a widely used antiplatelet drug, has been a cornerstone in the prevention of cardiovascular events in patients with atherosclerotic vascular disease. Clopidogrel works by inhibiting adenine diphosphate (ADP) induce platelet aggregation by binding to P2Y12 receptor. However, the story of clopidogrel serves as a cautionary tale in the era of pharmacogenomics and personalized medicine. The discovery of genetic variations in the CYP2C19 and P2Y12 that affect clopidogrel metabolism and efficacy, has significant implications for patient care.
References
Lopez J, Mark J, Duarte GJ, Shaban M, Sosa F, Mishra R, et al. Role of genetic polymorphisms in clopidogrel response variability: a systematic review. Open Heart. 2023;10(2):e002436.
Akkaif MA, Daud NAA, Sha’aban A, Ng ML, Abdul Kader MAS, Noor DAM, et al. The role of genetic polymorphism and other factors on clopidogrel resistance (CR) in an Asian population with coronary heart disease (CHD). Molecules. 2021;26(7):1987.
Lyu SQ, Yang YM, Zhu J, Wang J, Wu S, Zhang H, et al. The efficacy and safety of CYP2C19 genotype-guided antiplatelet therapy compared with conventional antiplatelet therapy in patients with acute coronary syndrome or undergoing percutaneous coronary intervention: a meta-analysis of randomized controlled trials. Platelets. 2020;31(8):971–80.
Ta Anh H, Nguyen Duy T, Bui Duc T, Hoang Van T, Nguyen Oanh O, Luong Cong T, et al. Association of P2RY12 gene variants and non-genetic factors with clopidogrel responsiveness in Vietnamese patients after percutaneous coronary intervention: a cross-sectional study. J Clin Lab Anal. 2025:e70003.
Danielak D, Pawlak K, Główka F, Karaźniewicz-Łada M. Influence of genetic and epigenetic factors of P2Y12 receptor on the safety and efficacy of antiplatelet drugs. Cardiovasc Drugs Ther. 2024; 38(3):621–36.
Pereira NL, Rihal C, Lennon R, Marcus G, Shrivastava S, Bell MR, et al. Effect of CYP2C19 genotype on ischemic outcomes during oral P2Y12 inhibitor therapy: a meta-analysis. JACC Cardiovasc Interv. 2021;14(7):739–50.
Lee CR, Luzum JA, Sangkuhl K, Gammal RS, Sabatine MS, Stein CM, et al. Clinical Pharmacogenetics Implementation Consortium guideline for CYP2C19 genotype and clopidogrel therapy: 2022 update. Clin Pharmacol Ther. 2022;112(5):959–67.
Pirmohamed M. Pharmacogenomics: current status and future perspectives. Nat Rev Genet. 2023; 24(6):350–62.
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