The Role of Genetic Polymorphism and Other Factors on Clopidogrel Resistance (CR) in an Asian Population with Coronary Heart Disease (CHD)

Mohammed Ahmed Akkaif, Nur Aizati Athirah Daud, Abubakar Sha'aban, Mei Li Ng, Muhamad Ali Sk Abdul Kader, Dzul Azri Mohamed Noor, Baharudin Ibrahim, Mohammed Ahmed Akkaif, Nur Aizati Athirah Daud, Abubakar Sha'aban, Mei Li Ng, Muhamad Ali Sk Abdul Kader, Dzul Azri Mohamed Noor, Baharudin Ibrahim

Abstract

Clopidogrel is a widely-used antiplatelet drug. It is important for the treatment and prevention of coronary heart disease. Clopidogrel can effectively reduce platelet activity and therefore reduce stent thrombosis. However, some patients still have ischemic events despite taking the clopidogrel due to the alteration in clopidogrel metabolism attributable to various genetic and non-genetic factors. This review aims to summarise the mechanisms and causes of clopidogrel resistance (CR) and potential strategies to overcome it. This review summarised the possible effects of genetic polymorphism on CR among the Asian population, especially CYP2C19 *2 / *3 / *17, where the prevalence rate among Asians was 23.00%, 4.61%, 15.18%, respectively. The review also studied the effects of other factors and appropriate strategies used to overcome CR. Generally, CR among the Asian population was estimated at 17.2-81.6%. Therefore, our overview provides valuable insight into the causes of RC. In conclusion, understanding the prevalence of drug metabolism-related genetic polymorphism, especially CYP2C19 alleles, will enhance clinical understanding of racial differences in drug reactions, contributing to the development of personalised medicine in Asia.

Keywords: CYP2C19 polymorphism 5; antiplatelet 3; clopidogrel 2; clopidogrel resistance 4; personalized medicine.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The metabolic pathway of clopidogrel and its target receptors.
Figure 2
Figure 2
Prevalence of the CYP2C19 * 2/*3/*17 alleles in the Asian population.
Figure 3
Figure 3
Drug interaction mechanism of clopidogrel with statins, calcium channel blockers (CCBs) and proton pump inhibitors (PPIs).

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