Статья
КЛИНИЧЕСКАЯ ФАРМАКОГЕНЕТИКА АНТИАГРЕГАНТОВ: ВЗГЛЯД КЛИНИЧЕСКОГО ФАРМАКОЛОГА
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.
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