Cigarette Smoking and Clopidogrel Interaction

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.