ВЗАИМОСВЯЗЬ МЕЖДУ КУРЕНИЕМ И АНТИАГРЕГАНТНЫМ ДЕЙСТВИЕМ КЛОПИДОГРЕЛА

К. Ю. Лукьянец; М. Л. Лындина

doi:10.32415/jscientia_2020_6_5_14-24

Авторы

К. Ю. Лукьянец Санкт-Петербургский государственный университет https://orcid.org/0000-0002-8910-7888
М. Л. Лындина Санкт-Петербургский государственный университет https://orcid.org/0000-0003-2672-0623

https://doi.org/10.32415/jscientia_2020_6_5_14-24

Ключевые слова:

клопидогрел, тромбоциты, антиагреганты, курение, парадокс курильщика

Аннотация

Клопидогрел является наиболее часто используемым антиагрегантным препаратом из группы ингибиторов P2Y12, которые активно применяются для вторичной профилактики атеротромботических сердечно-сосудистых событий ишемического генеза у пациентов, перенесших инфаркт миокарда и стентирование коронарных артерий. С учётом сложности метаболизма препарата и большого количества потенциальных лекарственных взаимодействий остро стоит проблема индивидуальной вариабельности антиагрегантного действия клопидогрела. Кроме того, одним из клинически значимых вопросов является так называемый «парадокс курильщика». Суть данного феномена заключается в том, что у ряда пациентов курение повышает эффективность антиагрегантного действия клопидогрела. В настоящем обзоре проанализированы данные зарубежных исследований последних лет об особенностях фармакокинетики и фармакодинамики клопидогрела у курящих, потенциальных причинах возникновения «парадокса курильщика» и о его возможном клиническом значении у пациентов с ишемической болезнью сердца. Затрагивается вопрос сравнительной эффективности различных представителей класса ингибиторов P2Y12, в том числе с точки зрения влияния курения. Обсуждаются фармакогенетические аспекты и проблемы персонализации антиагрегантной терапии.

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