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February 2, 2026Stroke

Abstract WP004: CYP2C19 Loss-of-Function Alleles and Early Imaging Outcomes in Clopidogrel-Treated Acute Ischemic Stroke

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Key result

CYP2C19 loss-of-function linked to ~72% higher risk of infarct growth in clopidogrel-treated stroke patients.

  • OR 1.43
  • 95% CI 0.74-2.84
  • P=0.11
  • n=317

Why the study?

Clopidogrel efficacy in acute ischemic stroke is influenced by CYP2C19 loss-of-function alleles, but previous studies have shown inconsistent results regarding outcome differences by genotype.

Does CYP2C19 loss-of-function allele carriage increase new ischemic lesions or infarct growth in clopidogrel-treated acute ischemic stroke patients?

Population

317 clopidogrel-treated acute ischemic stroke patients aged ≥20 years within 7 days of onset

Comparison

CYP2C19 loss-of-function allele carriers vs non-carriers

Design

Single-center prospective registry-based cohort study

Follow-up

90 days

Authors

KKKwang Hyun KimKyungpook National University HospitalMEMi‐Yeon EunKyungpook National University Hospital

Discussion

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Implication

LOF carriage was associated with infarct growth but not new lesions or outcomes; hypothesis-generating and leaves open genotype-guided therapy trials.

Key Points

  • To evaluate how CYP2C19 loss-of-function alleles influence outcomes in acute ischemic stroke patients treated with clopidogrel.
  • Single-center, prospective, registry-based cohort study conducted from January 2022 to June 2024.
  • Included patients aged ≥20 years with acute ischemic stroke within 7 days who received clopidogrel.
  • CYP2C19 genotyping classified patients as loss-of-function (LOF) carriers or non-carriers.
  • Primary outcome assessed was new ischemic lesions on day-5 diffusion-weighted imaging (DWI).
  • Secondary outcomes included infarct growth, functional outcome at 90 days, early neurological deterioration, and major bleeding.
  • New ischemic lesions observed in 24% of LOF carriers vs 17% of non-carriers (p=0.11).
  • Infarct growth was more frequent in LOF carriers (31% vs 18%, p=0.013).
  • Favorable functional outcome rates at 90 days were 78% in LOF carriers vs 84% in non-carriers (p=0.20).
  • LOF carrier status was not significantly associated with new ischemic lesions but increased risk of infarct growth (adjusted OR 1.93, 95% CI 1.08–3.53).
  • Other outcomes like END, ICH, major bleeding, and vascular death showed no significant differences.

Study Design

Type

Cohort (n=317)

Multicenter

No

Structured PICO

Does CYP2C19 loss-of-function allele carriage increase new ischemic lesions or infarct growth in clopidogrel-treated acute ischemic stroke patients?

P
Population
317 patients aged ≥20 years with acute ischemic stroke within 7 days of onset treated with clopidogrel, followed for up to 90 days.
E
Exposure
CYP2C19 loss-of-function (LOF) allele carriers (*2 or *3 alleles) treated with clopidogrel
C
Comparator
CYP2C19 non-carriers treated with clopidogrel
O
Outcome
New ischemic lesions on day-5 diffusion-weighted imaging (DWI)surrogate

Main Result

Odds Ratio: 1.43 (95% CI 0.74–2.84)

Absolute Event Rate: 24% vs 17%

p-value: p=0.11

In clopidogrel-treated acute ischemic stroke patients, CYP2C19 loss-of-function alleles were associated with early infarct growth on imaging, though not with new ischemic lesions or 90-day functional outcomes.

Cite This Study

Kim et al. (2026) conducted a cohort in acute ischemic stroke (n=317). CYP2C19 loss-of-function alleles vs. non-carriers was evaluated on new ischemic lesions on day-5 diffusion-weighted imaging (DWI) (OR 1.43, 95% CI 0.74-2.84, p=0.11). CYP2C19 loss-of-function alleles in clopidogrel-treated acute ischemic stroke were not significantly associated with new ischemic lesions at day 5 (24% vs 17%; adjusted OR 1.43; p=0.11).

synapsesocial.com/papers/6980fd18c1c9540dea80eda2https://doi.org/10.1161/str.57.suppl_1.wp004
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Cytochrome P450 2C19 Genotypes and Clopidogrel in Patients With Ischemic Stroke2025 · 9 citations
  2. 2Association Between CYP2C19 Loss-of-Function Allele Status and Efficacy of Clopidogrel for Risk Reduction Among Patients With Minor Stroke or Transient Ischemic Attack2016 · 379 citations
  3. 3CYP2C19 polymorphisms and clopidogrel efficacy in the secondary prevention of ischemic stroke: a retrospective observational study2021 · 15 citations
  4. 4Impact of CYP2C19 Genotype Status on Clinical Outcomes in Patients with Symptomatic Coronary Artery Disease, Stroke, and Peripheral Arterial Disease: A Systematic Review and Meta-Analysis2024 · 18 citations
  5. 5Increased frequency of CYP2C19 loss‐of‐function alleles in clopidogrel‐treated patients with recurrent cerebral ischemia2022 · 11 citations