phgenomicsФармакогенетика и фармакогеномикаPharmacogenetics and Pharmacogenomics2588-05272686-8849LLC "Izdatelstvo OKI"10.37489/2588-0527-2022-1-74-77phgenomics-247Research ArticleОПИСАНИЕ СЛУЧАЯCASE STUDYГеморрагические церебральные осложнения на фоне терапии клопидогрелом у больных ишемическим инсультом при полиморфном носительстве CYP2C19*17: клинический случайHemorrhagic cerebral complications on the background of therapy with clopidogrel in patients with ischemic stroke with CYP2C19*17 polymorphous carriage: a clinical casehttps://orcid.org/0000-0002-4496-3680СычёвД. А.SychevD. A.

д. м. н., профессор, член-корр. РАН, ректор, зав. кафедрой клинической фармакологии и терапии имени академика Б. Е. Вотчала

Москва

Dr. Sci. (Med.), professor, Corresponding Member RAS, Rector, Head Department of the Clinical Pharmacology and Therapy named after academician B. E. Votchal

Moscow

dimasychev@mail.ruhttps://orcid.org/0000-0001-9498-4503КитаеваЕ. Ю.KitaevaE. Yu.

к. м. н., доцент кафедры геронтологии, гериатрии и клинической фармакологии

Иркутск

Cand. Sci. Med., Associate Professor of the Department of Gerontology, Geriatrics and Clinical Pharmacology

Irkutsk

kitaevaey@mail.ruhttps://orcid.org/0000-0003-1650-1275ШпрахВ. В.ShprakhV. V.

д. м. н., профессор, заслуженный деятель науки РФ, заслуженный врач РФ, директор и заведующий кафедрой неврологии и нейрохирургии

Иркутск

Dr. Sci. (Med.), professor, Honored Scientist of the Russian Federation, Honored Doctor of the Russian Federation, Director and Head of the Department of Neurology and Neurosurgery ISMAPgE

Irkutsk

irkmapo@irk.ruhttps://orcid.org/0000-0002-9307-4994МирзаевК. Б.MirzaevK. B.

д. м. н., проректор по научной работе и инновациям

Москва

Dr. Sci. (Med.), Vice-Rector for Research and Innovation

Moscow

karin05doc@yandex.ruФедеральное государственное бюджетное образовательное учреждение дополнительного профессионального образования «Российская медицинская академия непрерывного профессионального образования» Министерства здравоохранения Российской ФедерацииРоссияFederal State Budgetary Educational Institution of Further Professional Education “Russian Medical Academy of Continuous Professional Education” of the Ministry of Healthcare of the Russian FederationRussian FederationИркутская государственная медицинская академия последипломного образования — филиал федерального государственного бюджетного образовательного учреждения дополнительного профессионального образования «Российская медицинская академия непрерывного профессионального образования» Министерства здравоохранения Российской ФедерацииРоссияIrkutsk State Medical Academy of Postgraduate Education — Branch Campus of the Federal State Budgetary Educational Institution of Further Professional Education “Russian Medical Academy of Continuous Professional Education” of the Ministry of Healthcare of the Russian FederationRussian Federation202227022023017477Copyright © Сычёв Д.А., Китаева Е.Ю., Шпрах В.В., Мирзаев К.Б., 20232023Сычёв Д.А., Китаева Е.Ю., Шпрах В.В., Мирзаев К.Б.Sychev D.A., Kitaeva E.Y., Shprakh V.V., Mirzaev K.B.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.pharmacogenetics-pharmacogenomics.ru/jour/article/view/247

Цель исследования. Продемонстрировать на клиническом примере важность проведения у больных ишемическим инсультом, получающих клопидогрел, фармакогенетического тестирования с целью выявления полиморфного носительства CYP2C19*17 (C806T, rs12248560). Материалы и методы. Проводили клинико-лабораторное обследование 121 больного ишемическим инсультом, определяли полиморфизм CYP2C19*17 (C806T, rs12248560), ассоциированный с повышением эффективности клопидогрела, низкой остаточной реактивностью тромбоцитов и повышенным риском кровотечений. Носительство полиморфных маркеров определялось методом полимеразной цепной реакции в режиме реального времени. Результаты и заключение. У двух пациентов (1,7 %) — носителей полиморфных маркеров CYP2C19*17 — выявлены геморрагические цереброваскулярные осложнения на фоне применения клопидогрела. Желудочно-кишечные кровотечения, как и другие осложнения антиагрегантной терапии, в данном исследовании зарегистрированы не были.

Objective. To demonstrate on a clinical example the importance of conducting pharmacogenetic testing in patients with ischemic stroke receiving clopidogrel in order to identify the polymorphic carriage of CYP2C19*17 (C806T, rs12248560). Materials and methods. A clinical and laboratory examination of 121 patients with ischemic stroke was carried out, the CYP2C19*17 polymorphism (C806T, rs12248560) associated with an increase in the effectiveness of clopidogrel, low residual platelet reactivity, and an increased risk of bleeding was determined. Carriage of polymorphic markers was determined by real-time polymerase chain reaction. Results and conclusion. In two patients (1.7 %), carriers of polymorphic markers CYP2C19*17, hemorrhagic cerebrovascular complications were detected on the background of clopidogrel. Gastrointestinal bleeding, as well as other complications of antiplatelet therapy, are not registered in practice

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The authors declare that there are no conflicts of interest present.