[Clopidogrel cannot yet be exclusively for smokers]

Abstract

Dual antiplatelet therapy with acetylsalicylic acid and a P2Y12 receptor antagonist is the cornerstone of treatment in patients with acute coronary syndromes and patients undergoing coronary stenting. Two recent meta-analyses concluded that the efficacy of the P2Y12 receptor antagonist clopidogrel in reducing cardiovascular events is more pronounced in smokers than in non-smokers. Most probably, this is due to induction of cytochrome p450 1A2 by smoking, which accelerates conversion of clopidogrel to its active metabolite. These observations are of great interest. However, before these observations can be used to guide treatment in the clinical arena, the effect of smoking should be studied in prospective clinical trials, investigating not only its modulation of the efficacy but also of the bleeding complications of clopidogrel.