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Genetic polymorphisms and drug interactions leading to clopidogrel resistance: why the Asian population requires

Md Shariful Hasan1, Hamidon Bin Basri, Lim Poh Hin

  • 1Neurology Unit, Department of Medicine and Institute of Gerontology, Faculty of Medicine and Health Sciences, University Putra Malaysia, Serdang, Selangor Darul Ehsan, Malaysia. shariful_hsn@yahoo.com

The International Journal of Neuroscience
|November 1, 2012
PubMed

Insights

Clopidogrel response varies significantly, especially in Asian populations, increasing risks for cardiovascular events. Genetic factors and drug interactions can reduce its antiplatelet effectiveness, necessitating clinical awareness.

Area of Science:

  • Cardiology
  • Pharmacogenomics
  • Vascular Medicine

Background:

  • Ischemic heart disease and stroke are leading global causes of death.
  • Antiplatelet therapy, particularly clopidogrel, is crucial for preventing recurrent ischemic events.
  • Individual responses to clopidogrel vary, impacting its efficacy.

Purpose of the Study:

  • To highlight the significant interindividual variability in antiplatelet response to clopidogrel.
  • To emphasize the increased prevalence of clopidogrel hyporesponse in Asian populations due to genetic factors.
  • To inform clinicians about potential drug interactions that decrease clopidogrel's effectiveness.

Main Methods:

  • Review of existing literature on clopidogrel response and influencing factors.
  • Analysis of pharmacogenetic data related to clopidogrel metabolism and resistance.
  • Examination of drug-drug interactions affecting clopidogrel's antiplatelet activity.

Main Results:

  • Wide interindividual variability in clopidogrel's antiplatelet effect observed.
  • Hyporesponders and nonresponders face higher risks of adverse cardiovascular events.
  • Certain medications (e.g., proton pump inhibitors) and genetic polymorphisms (common in Asians) significantly reduce clopidogrel efficacy.
  • Prevalence of clopidogrel resistance can be as high as 70% in some Asian communities.

Conclusions:

  • Clinicians must consider individual patient variability, especially genetic factors prevalent in Asian populations, when prescribing clopidogrel.
  • Awareness of drug interactions is critical to optimize antiplatelet therapy.
  • Current guidelines may not adequately address the need for personalized antiplatelet treatment strategies.

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