Clopidogrel efficacy and cigarette smoking status

摘要

RECENT ANALYSES OF LARGE-SCALE TRIALS SUGGEST either a reduced or complete lack of clinical benefit from clopidogrel therapy in nonsmokers. Importantly, this observation is not explained by an enhanced pro thro mbo tic state (a condition in which P2Y_(12) inhibitor therapy may be expected to be most effective) in smokers relative to nonsmokers as evidenced by variable event rates in smokers and nonsmokers treated with placebo. Cigarette smoking induces the activity of cyto-chrome P450 (CYP) 1A2, an isoenzyme involved in the metabolic activation of clopidogrel but less recognized in importance than CYP2C19. Nonsmokers have greater platelet reactivity than smokers during clopidogrel treatment.