缺血性脑卒中患者对氯吡格雷的耐药性

IF 1.9 4区 医学 Q3 CLINICAL NEUROLOGY
Annals of Indian Academy of Neurology Pub Date : 2024-09-01 Epub Date: 2024-07-24 DOI:10.4103/aian.aian_79_24
S Lavanya, Dhanashri Babu, D Dheepthi, E Dhinakar, G Vivekanandh
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引用次数: 0

摘要

摘要:2019年,中风仍是全球第二大死亡原因。抗血小板药物氯吡格雷用于防止中风患者形成血栓。尽管大多数人认为氯吡格雷是安全和有益的,但每个患者的反应不可避免地存在差异。本综述涉及中风患者的氯吡格雷耐药性、其风险因素和识别方法。氯吡格雷耐药的特点是药物无法阻止靶酶发挥作用。缺血性中风患者的预后和对氯吡格雷的反应性受各种基因多态性 CYP2C19 基因型的显著影响。研究发现,CYP2C19 *2和CYP2C19 *3这两种主要的突变等位基因是最普遍的基因型。治疗 6 个月后的 mRS 评分较好,表明没有这些 CYP2C19 变异等位基因的患者的反应率较高。其他因素包括药物间相互作用(质子泵抑制剂)、人口统计学(年龄、性别、社会史)、合并症等。检测血小板反应性的血样是在出院一个月后从外周血样本中抽取的。有几种方法可用于识别氯吡格雷抗药性。其中包括 ADP 诱导的血小板聚集、血小板反应性指数 VASP、Verify Now Assay、TEG 分析仪、血浆 microRNA-223。在 CR 的情况下,可以选择非原研药且其代谢不依赖于 CYP2C19 的药物作为优选药物。替卡格雷就是一种有效的替代药物。质子泵抑制剂和氯吡格雷只能在有可靠临床指征的患者中同时使用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clopidogrel Resistance in Ischemic Stroke Patients.

Stroke remained the second leading cause of death globally in 2019. The antiplatelet drug clopidogrel is used to keep blood clots from forming in people who have experienced a stroke. Although most people find clopidogrel to be safe and beneficial, there is inevitably a range in how each patient responds. The review covers about Clopidogrel resistance in stroke patients, their risk factors and the methods to identify it. Clopidogrel resistance is characterized as the drug's inability to prevent the target enzyme from acting. The prognosis of patients with ischemic stroke and the responsiveness to clopidogrel are significantly impacted by the various genetic polymorphism CYP2C19 genotypes. The two primary mutant alleles, CYP2C19 *2 and CYP2C19 *3, have been found to be the most prevalent genotypes. Better mRS scores six months after treatment showed a higher response rate in patients without these CYP2C19 variant alleles. Other factors are drug-drug interaction (proton pump inhibitors), demographics (age, sex, social history), comorbid conditions, etc. Blood samples for testing platelet reactivity were drawn one month after discharge from a peripheral blood sample. Several methods are used to identify the clopidogrel resistance. Some of them are ADP-Induced platelet aggregation, Platelet Reactivity Index VASP, Verify Now Assay, TEG Analyzer, Plasma microRNA-223. Drugs that are not prodrugs and whose metabolism is not dependent upon CYP2C19 can be selected as a superior alternative in case of CR. Ticagrelor is one such effective substitute. Proton pump inhibitors and clopidogrel should only be used concurrently in patients with reliable clinical indications.

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来源期刊
Annals of Indian Academy of Neurology
Annals of Indian Academy of Neurology Nervous System Diseases-
CiteScore
2.20
自引率
11.80%
发文量
293
审稿时长
29 weeks
期刊介绍: The journal has a clinical foundation and has been utilized most by clinical neurologists for improving the practice of neurology. While the focus is on neurology in India, the journal publishes manuscripts of high value from all parts of the world. Journal publishes reviews of various types, original articles, short communications, interesting images and case reports. The journal respects the scientific submission of its authors and believes in following an expeditious double-blind peer review process and endeavors to complete the review process within scheduled time frame. A significant effort from the author and the journal perhaps enables to strike an equilibrium to meet the professional expectations of the peers in the world of scientific publication. AIAN believes in safeguarding the privacy rights of human subjects. In order to comply with it, the journal instructs all authors when uploading the manuscript to also add the ethical clearance (human/animals)/ informed consent of subject in the manuscript. This applies to the study/case report that involves animal/human subjects/human specimens e.g. extracted tooth part/soft tissue for biopsy/in vitro analysis.
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