Abstrakt:
Antiplatelet agents are the mainstay treatment
in the prevention and management of atherothrombotic
complications. However, a substantial interpatient variability
in response to clopidogrel has been reported. Furthermore,
patients with coronary artery disease and lesser
platelet inhibition in response to clopidogrel are at
increased risk for cardiovascular events. Clopidogrel after
absorption requires two-step oxidation by the hepatic
cytochrome P450 to generate its active metabolite. Polymorphisms
of genes encoding the cytochrome enzymes and
P-glycoprotein involved in clopidogrel absorption are
regarded as major determinants of the interindividual variability
in the clopidogrel-induced platelet inhibition. In
our review we discuss the prevalence and clinical significance
of various alleles of the genes: CYP2C19 and
ABCB1 in the setting of coronary artery disease. Allele
CYP2C19*2 is associated with excess of ischaemic events
including myocardial infarction and stent thrombosis. On
the other hand, CYP2C19*17 allele poses a serious threat
of bleeding. Data concerning the prognostic value of
genetic variant 3435C?T of ABCB1 remain inconclusive.
