КЛИНИЧЕСКАЯ ЗНАЧИМОСТЬ ГЕНЕТИЧЕСКОГО ТЕСТИРОВАНИЯ ПАЦИЕНТОВ ПОСЛЕ КАРДИО-ИНТЕРВЕНЦИОННЫХ ВМЕШАТЕЛЬСТВ
Клинический случай
Дата публикации: декабря 7, 2022
Ключевые слова
клопидогрел
блокатор P2Y12-рецептора
генетический поли- морфизм СYP2C19
блокатор P2Y12-рецептора
генетический поли- морфизм СYP2C19
Как цитировать
Ковтун Н. А., Савельева М. И., Баринов В. Е., Закарян Н. В., Бояринцев В. В. КЛИНИЧЕСКАЯ ЗНАЧИМОСТЬ ГЕНЕТИЧЕСКОГО ТЕСТИРОВАНИЯ ПАЦИЕНТОВ ПОСЛЕ КАРДИО-ИНТЕРВЕНЦИОННЫХ ВМЕШАТЕЛЬСТВ // Кремлевская медицина. Клинический вестник. 2022. Т. № 3. С. 144-147.
Аннотация
Сердечно-сосудистые заболевания (ССЗ) в настоящее время занимают лидирующее позиции среди причин смертности во многих странах мира. Антитромбоцитарная терапия, включающая блокатор P2Y12-рецептора, является важным компонентом лечения больных c инфарктом миокарда и ишемическим инсультом. Одной из клинических проблем в процессе лечения пациентов с ССЗ является вариабельность ответа на блокаторы P2Y12-рецепторов. В подобной вариабельности ответа на антиагреганты большое значение придается генетическим факторам. Клопидогрел остается наиболее широко назначаемым антитромбоцитарным препаратом. В статье представлен клинический случай пациента после кардиоинтервеционного вмешательства с тромбозом стента правой коронарной артерии и гетерозиготной формой мутации СYP2C19.Литература
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summary) // Eur Heart J Qual Care Clin Outcomes. – 2020. – V. 6. – No 1. – P. 7–9.
2. Шаповал И.Н. и др. Здравоохранение в России. 2019: стат. сб. Росстат. – М.: З-46. – 2019. – Т. 170. [Shapoval I.N. et al. Healthcare in Russia. 2019: stat. sat. Rosstat. – M.: Z-46. – 2019. – V. 170. In Russian].
3. Layne K. et al. The role of platelets in the pathophysiology of atherosclerosis and its complications // Cardiovascular thrombus: from pathology and clinical presentations to imaging, pharmacotherapy and interventions. – Elsevier, 2018. – P. 51–65.
4. Karve A.M. et al. Contemporary use of ticagrelor in interventional practice (from Blue Cross Blue Shield of Michigan Cardiovascular Consortium) // Am J Cardiol. – 2015. – V. 115. – No 11. – P. 1502–1506.
5. Price M.J. et al. Influence of genetic polymorphisms on the effect of high- and standard-dose clopidogrel after percutaneous coronary intervention: the GIFT (Genotype Information and Functional Testing) study // J Am Coll Cardiol. – 2012. – V. 59. – No 22. – P. 1928–1937.
6. Pereira N.L. et al. Clopidogrel pharmacogenetics: state- of-the-art review and the TAILOR-PCI Study // Circ Cardiovasc Interv. – 2019. – V. 12. – No 4. – P. e007811.
7. Ferri N. et al. Pharmacology of the new P2Y12 receptor inhibitors: insights on pharmacokinetic and pharmacodynamic properties // Drugs. – 2013. – V. 73. – No 15. – P. 1681–1709.
8. Holmes M.V. et al. CYP2C19 genotype, clopidogrel metabolism, platelet function, and cardiovascular events: a systematic review and meta-analysis // JAMA. – 2011. – V. 306. – No 24. – P. 2704–2714.
9. Sibbing D. et al. Guided de-escalation of antiplatelet treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention (TROPICAL-ACS): a randomised, open-label, multicentre trial // Lancet. – 2017. – V. 390. – No 10104. – P. 1747–1757.
10. Oh I.Y. et al. Association of cytochrome P450 2C19* 2 polymorphism with clopidogrel response variability and cardiovascular events in Koreans treated with drug-eluting stents // Heart. – 2012. – V. 98. – No 2. – P. 139–144.
11. Mega J.L. et al. Reduced-function CYP2C19 genotype and risk of adverse clinical outcomes among patients treated with clopidogrel predominantly for PCI: a meta-analysis // JAMA. – 2010. – V. 304. – No 16. – P. 1821–1830.
12. Holmes D.R. et al. ACCF/AHA Clopidogrel clinical alert: approaches to the FDA “boxed warning” a report of the American College of Cardiology foundation task force on clinical expert consensus documents and the American Heart Association endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons // J Am Coll Cardiol. – 2010. – V. 56. – No 4. – P. 321–341.