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КЛИНИЧЕСКАЯ ФАРМАКОГЕНЕТИКА АНТИАГРЕГАНТОВ: ВЗГЛЯД КЛИНИЧЕСКОГО ФАРМАКОЛОГА

https://doi.org/10.15829/1560-4071-2007-4-91-99

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Аннотация

В обзоре рассмотрены проблемы индивидуальной чувствительности к антиагрегантам. Ацетилсалициловая кислота, по данным многочисленных исследований, неэффективна у 5 % пациентов. Это может быть связано с полиморфизмом гена, кодирующего молекулу-мишень ацетилсалициловой кислоты - циклооксигеназы 1. При этом данный феномен имеет большое клиническое значение, т. к. у пациентов, резистентных к ацетилсалициловой кислоте, существенно выше риск тромботических осложнений. Другой широко применяемый антиагрегант - клопидогрель - не вызывает необходимого снижения агрегации более чем у 15 % больных. Эффективность клопидогреля зависит от активности печеночных изферментов CYP3A, а также от варианта гена, кодирующего рецептор к АДФ. По результатам многочисленных исследований, резистентность к клопидогрелю значительно ухудшает прогноз у пациентов с ИБС. Не избежали проблемы резистентности и препараты из новой группы антиагрегантов: блокаторы IIb/IIIa рецепторов тромбоцитов. Они недостаточно эффективны у 20 % пациентов, что связано с полиморфизмом генов, кодирующих рецепторы к гликопротеинам. Таким образом, для подбора оптимального режима антиагрегантной терапии представляется целесообразным и перспективным индивидуальный подход к пациентам с использованием генетических тестов, основанных на данных фармакогенетических исследований.

Об авторах

Д. А. Сычев
Московская медицинская академия им. И.М. Сеченова
Россия
кафедра клинической фармакологии


А. В. Зятенков
Московская медицинская академия им. И.М. Сеченова
Россия
кафедра клинической фармакологии


В. Г. Кукес
Институт клинической фармакологии НЦ ЭСМП Росздравнадзора
Россия


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Для цитирования:


Сычев Д.А., Зятенков А.В., Кукес В.Г. КЛИНИЧЕСКАЯ ФАРМАКОГЕНЕТИКА АНТИАГРЕГАНТОВ: ВЗГЛЯД КЛИНИЧЕСКОГО ФАРМАКОЛОГА. Российский кардиологический журнал. 2007;(4):91-99. https://doi.org/10.15829/1560-4071-2007-4-91-99

For citation:


Syche D.A., Zyatenkov A.V., Kukes B.G. Clinical pharmacogenetics of antiaggregants: clinical pharmacologist' point of view. Russian Journal of Cardiology. 2007;(4):91-99. (In Russ.) https://doi.org/10.15829/1560-4071-2007-4-91-99

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