Adherence to CYP2C19-guided antiplatelet therapy using lab-based genotyping significantly reduced 90-day recurrent stroke (OR 0.12; 95% CI 0.03-0.58; p=0.008).
Cohort (n=167)
No
Does adherence to CYP2C19-guided dual antiplatelet therapy using lab-based genotyping reduce 90-day recurrent stroke and composite vascular events in patients with minor and transient ischemic stroke?
Adherence to CYP2C19-guided dual antiplatelet therapy using lab-based genotyping significantly reduces 90-day recurrent stroke in patients with minor and transient ischemic stroke.
Effect estimate: OR 0.12 (95% CI 0.03-0.58)
p-value: p=0.008
Abstract Background and aims CYP2C19 loss-of-function (LOF) allele carriers benefit from ticagrelor-aspirin over clopidogrel-aspirin for secondary stroke prevention. However, implementing CYP2C19-guided dual antiplatelet therapy (DAPT) is challenging in centers relying on lab-based testing with prolonged turnaround time. This study evaluates adherence to CYP2C19-guided DAPT using lab-based genotyping and its impact on 90-day recurrent stroke and composite vascular events. Methods We conducted a single-centre retrospective study (2023-2024) involving minor and transient ischemic stroke patients. Patients were initially treated with ticagrelor-aspirin or clopidogrel-aspirin based on clinicians’ preference. Following lab-based CYP2C19 genotype results, antiplatelet was switched when indicated with adherence defined as final treatment consistent with genotype results (LOF allele carrier receiving ticagrelor and non-LOF allele carrier receiving clopidogrel). Results Of 167 acute ischemic stroke patients, 86 (51.5%) were LOF allele carriers and 81 (48.5%) were non-LOF allele carriers. Median age was 63 years and median CYP2C19 test turnaround time was 2 (1-4) days. Overall adherence to CYP2C19-guided antiplatelet therapy was 67.7% where LOF allele carriers was 59.3% and non-LOF allele carriers was 40.7% (p=0.004). Recurrent stroke occurred within 90 days in 8 patients (9.3%) among LOF carriers and 2 patients (2.5%) among non-LOF carriers (OR 7.5495%CI 1.35-42.02,p=0.021). Adherence to CYP2C19-guided antiplatelet therapy resulted in significant reduction of 90-day recurrent stroke (OR 0.12 95%CI 0.03-0.58, p=0.008) but a non-significant reduction in composite vascular event (OR 0.3195%CI 0.09-1.10, p=0.07). Conclusions Adherence to CYP2C19-guided antiplatelet therapy with lab-based genotyping may reduce 90-day recurrent stroke and composite vascular events. Conflict of interest Chia Xuan Teoh: nothing to disclose
Teoh et al. (Fri,) conducted a cohort in Minor and transient ischemic stroke (n=167). Adherence to CYP2C19-guided dual antiplatelet therapy vs. Non-adherence was evaluated on 90-day recurrent stroke (OR 0.12, 95% CI 0.03-0.58, p=0.008). Adherence to CYP2C19-guided antiplatelet therapy using lab-based genotyping significantly reduced 90-day recurrent stroke (OR 0.12; 95% CI 0.03-0.58; p=0.008).