On Thursday, 15 May, in an open meeting of the Pharmacy Promotion Council of RSU, Ms Inga Urtāne will defend her doctoral thesis Impact of genetic factors on the efficiency of additional dose of Clopidogrel in ensuring personalized therapy in patients with hyporesponsivity.
On 15 May at 15:00, in an open meeting of the Pharmacy Promotion Council of Rīga Stradiņš University that will take place in Hippocrates lecture theatre (Rīga, 16 Dzirciema Street), Ms Inga Urtāne will defend her doctoral thesis Impact of genetic factors on the efficiency of additional dose of Clopidogrel in ensuring personalized therapy in patients with hyporesponsivity.
Cardiovascular diseases are still a significant health care problem in Latvia and worldwide, which is substantiated with the high mortality, morbidity and hospitalisation figures. By finding narrowings in heart arteries, the patient is inserted a stent (bio-metallic prosthesis, which prevents the blood vessels from narrowing). As a result of this procedure the platelets stick to the internal walls of the damaged blood vessel and may stick together thus forming a blood clot, which may repeatedly block the blood vessel. Therefore after such a procedure the patients shall use agents reducing the coagulation such as the Clopidogrel, which variously affects patients – more or less effective.
Although the reduced efficiency of Clopidogrel has been tried to avoid by additional saturating doses (SD) and higher maintaining doses (MD), yet it still is unclear, how the genes affect the reaction of patients to Clopidogrel.
The aim of the doctoral thesis was to identify, how the genetic features of patients affect their reaction to Clopidogrel, respectively, whether the gene (cytochrome (CYP) 2C19, CYP2C9 and ABCB1) options (differences in genes) in patients affect the additional Clopidogrel SD (600 mg) and increased MD (150 mg) effect for avoiding the reduced efficiency.
Several tasks were set to reach the aim – to analyse efficiency differences of the standard SD and MD, additional SD and increased MD of Clopidogrel in genes, to identify patients with a true Clopidogrel resistance (non-efficiency), to determine the impact of physiologic factors and simultaneously received medicinal therapy on the standard and additional SD and MD of Clopidogrel.
The study found out that the efficiency of standard SD and additional SD of Clopidogrel is reduced in patients with particular gene option (CYP2C19*2). The higher 150 mg MD of Clopidogrel in these patients is more efficient, but still is insufficient for 29% of cases. True resistance to Clopidogrel is observed rarely – in 2.1 % of patients, with whom the latest generation anticoagulation drug – Ticagrelor – is efficient. Higher body mass index and simultaneous therapy with other drugs is related with the tendency to reduced efficiency of Clopidogrel.
The study data show the opportunity to develop genetic tests with an aim to select the most efficient drugs for each single patient by optimising their dose considering his/her genotype.