Cigarette Smoking and Clopidogrel Interaction

  • Kristopher J. Swiger
  • Omair Yousuf
  • Kevin P. Bliden
  • Udaya S. Tantry
  • Paul A. Gurbel
Ischemic Heart Disease (D Mukherjee, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Ischemic Heart Disease

Abstract

Dual antiplatelet therapy (DAPT) with aspirin and an adenosine diphosphate receptor antagonist is central to the modern management of acute coronary syndromes and percutaneous revascularization. The most widely used adenosine diphosphate receptor antagonist, clopidogrel therapy is limited by inter-individual variability in platelet inhibition. Recent data suggest a potential role of smoking in the metabolism of clopidogrel and high on-treatment platelet reactivity. Pharmacodynamic studies and post-hoc analyses of large clinical trials support a link between smoking status and the efficacy of clopidogrel therapy. The mechanism of the interaction between smoking status and clopidogrel efficacy remains unclear but may be mediated by cytochrome P450 (CYP)1A2. There is less evidence available on the influence of smoking status on platelet reactivity and clinical outcomes during prasugrel and ticagrelor therapy.

Keywords

Clopidogrel Dual antiplatelet therapy Acute coronary syndrome Tobacco use Smoking Percutaneous revascularization Adenosine diphosphate receptor antagonist Prasugrel Ticagrelor High on-treatment platelet reactivity Percutaneous coronary intervention 

Notes

Conflict of Interest

K.J. Swiger declares that he has no conflict of interest.

O. Yousuf declares that he has no conflict of interest.

U. Tantry has received support for travel to meetings for the study or other purposes from DCRI. He has also received travel/accommodations/meeting expenses unrelated to activities listed from Accumetrics.

P.A. Gurbel has received support for travel to meetings for the study or other purposes from DCRI. He has been a consultant for Daiichi Sankyo, Lilly, Boehringer Ingleheim, Merck, Medtronic, Iverson Genetics, Pozen, Novartis, Bayer, Astrazeneca, Accumetrics, Nanosphere, Sanofi Aventis, CSL, Hemonetics. He has received grant support from NIH, Daiichi Sankyo/Lilly, Pozen, CSL, Astra Zeneca, Sanofi Aventis, Haemoscope, HCRI, DCRI. He has also received payment for development of educational presentations from Schering Plough, Discovery Channel, Primed and has stock/stock options in Merck, Pfizer, Medtronic.

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Kristopher J. Swiger
    • 1
  • Omair Yousuf
    • 1
  • Kevin P. Bliden
    • 2
  • Udaya S. Tantry
    • 3
  • Paul A. Gurbel
    • 3
    • 4
  1. 1.Johns Hopkins University School of MedicineBaltimoreUSA
  2. 2.Sinai Center for Thrombosis ResearchSinai Hospital of BaltimoreBaltimoreUSA
  3. 3.Sinai Center for Thrombosis ResearchSinai Hospital of BaltimoreBaltimoreUSA
  4. 4.Cardiac Catheterization LaboratoryBaltimoreUSA

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