Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
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Advances in Clinical and Experimental Medicine

2013, vol. 22, nr 6, November-December, p. 875–885

Publication type: review article

Language: English

Modern Antiplatelet Therapy – Opportunities and Risks

Nowoczesne leczenie przeciwpłytkowe – szanse i zagrożenia

Marcin Protasiewicz1,2,A,D,F, Paweł Szymkiewicz1,2,A,B,D,G, Wiktor Kuliczkowski3,D,E, Andrzej Mysiak1,2,D,E,F, Wojciech Witkiewicz1,4,5,E

1 Wrovasc – Integrated Cardiovascular Centre, Regional Specialist Hospital in Wrocław, Research and Development Centre, Poland

2 Department of Cardiology, Wroclaw University Hospital, Poland

3 3rd Department of Cardiology with Clinical Unit, Silesian Centre for Heart Diseases, Zabrze, Poland

4 General and Vascular Surgery Unit, Regional Specialist Hospital, Research and Development Centre in Wrocław, Poland

5 Department of Animal Physiology and Biostructure, Wrocław University of Environmental and Life Sciences, Poland

Abstract

Resistance to clopidogrel has been extensively investigated and described by researchers from many countries. Subsequent studies have contributed to a better understanding of the complex mechanisms in which clopidogrel is metabolised and have confirmed the negative effects on prognosis, both in a group of patients with low and excessive response to the drug. To prevent the dramatic consequences of an abnormal response to clopidogrel, 2 different strategies were adopted. The 1st employs the identification of patients based on platelet function tests, and genotyping and increasing the drug dose until the required aggregation parameters are achieved. The 2nd strategy is focused on developing new generation drugs whose efficacy will show fewer individual variations. So far diagnostic methods and tailored therapy have not been conclusively accepted for the treatment of patients, because novel pharmaceuticals have emerged providing more rapid action and beneficial effects, but without the disadvantages of clopidogrel. Still, there is a group of patients for whom clopidogrel remains the preferred choice, and considering the economic aspect, this drug can play a significant role in the treatment of many patients
Results. (Adv Clin Exp Med 2013, 22, 6, 875–885).

Streszczenie

Oporność na klopidogrel to zjawisko szeroko badane i opisywane na całym świecie. Kolejne prace przyniosły lepsze zrozumienie złożonych mechanizmów metabolicznych przemian klopidogrelu i potwierdziły niekorzystny wpływ na rokowanie zarówno w grupie chorych prezentujących słabszą, jak i nadmierną odpowiedź na leczenie tym lekiem. W celu zapobiegnięcia dramatycznym następstwom nieprawidłowej reakcji na klopidogrel przyjęto 2 odmienne strategie postępowania: opartą na identyfikacji chorych na podstawie testów płytkowych oraz genetycznych i intensyfikacji dawkowania leku aż do uzyskania oczekiwanych parametrów agregacji lub stworzenie nowej generacji leków, których skuteczność działania nie będzie tak silnie osobnicza. Obecnie diagnostyka i terapia indywidualna nie zostały jednoznacznie zaakceptowane w leczeniu chorych z uwagi na pojawienie się nowych farmaceutyków, które oferują szybsze i skuteczniejsze działania oraz nie mają wad klopidogrelu. Pozostaje jednak grupa chorych, w której klopidogrel, wydaje się, jest wciąż preferowany w leczeniu, a uwzględniając kontekst ekonomiczny, może odgrywać znaczącą rolę w terapii wielu chorych

Key words

clopidogrel resistance, platelet aggregation, antiplatelet therapy.

Słowa kluczowe

odporność na klopidogrel, agregacja płytek krwi, leczenie przeciwpłytkowe.

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