Data Management And Sharing System of China National Clinical Research Center for Neurological Diseases

《国家中心数据管理与共享系统操作说明书 —— 研究者部分》

Impact of Glycemic Control on Effcacy of Clopidogrel in Transient Ischemic Attack or Minor Stroke Patients With CYP2C19 Genetic Variants

First author：Yi Lin,Anxin Wang

Corresponding author：Yongjun Wang,Yilong Wang

clopidogrel cytochrome P-450 CYP2C19 glycosylated

essential_information

  • Person in charge：Yi Lin,Anxin Wang
  • Data Sources： CHANCE
  • Number of papers：CHANCE20180042
  • Published time：2017-04-29

2017-04-29

Published articles

Journal：Stroke

Publication type: Original Contributions

IF(IF): 7.914

PMID: 28289237 Link To Pubmed Full text Download

Background And Purpose

Dysglycemia may influence the predictive value of CYP2C19 loss-of-function allele for clinical efficacy of antiplatelet drug, but the role of glycated albumin (GA) remains unclear in patients with stroke on antiplatelet drugs.

Method

The CHANCE trial (Clopidogrel in High-Risk Patients With Acute Nondisabling Cerebrovascular Events) included 2933 patients who had GA levels and CYP2C19 genotyping. Cox proportional hazards model was used to assess the interaction between CYP2C19 loss-of-function allele (*2, *3) carrier status and the effect of antiplatelet therapy based on their GA levels.

Conclusion

In patients with minor stroke or high-risk transient ischemic attack, clopidogrel–aspirin when compared with aspirin alone reduced stroke recurrence only in noncarriers of CYP2C19 loss-of-function allele and normal GA levels.

Main results

There was significant interaction between carrier status and antiplatelet therapy regimen on the risk of recurrent stroke (P=0.03) in patients with GA levels of ≤15.5%, but not in those with GA levels of >15.5% (P=0.48). Only in noncarriers with low GA levels, dual-antiplatelet therapy reduced stroke recurrence (3.5%) compared with those on aspirin alone (14.7%; hazard ratio, 0.23; 95% confidence interval, 0.10–0.49; P<0.001). Similar effects were observed when examined the combined vascular event or ischemic stroke. No significant difference in bleeding was found among groups.