What question did this study set out to answer?

To evaluate the clinical role and current evidence base of CYP2C19 genotyping for directing antiplatelet therapy after an ischemic stroke or transient ischemic attack.

July 3, 2022Expert Review of Clinical PharmacologyOpen Access

The role of CYP2C19 genotyping to guide antiplatelet therapy following ischemic stroke or transient ischemic attack

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Why the study?

Evidence that CYP2C19 loss-of-function allele carriers on clopidogrel have increased risk for vascular events following TIA or ischemic stroke is less certain outside of Han-Chinese ancestry populations.

Does CYP2C19 genotyping to guide antiplatelet therapy reduce further vascular events in patients following ischemic stroke or TIA?

Population

Patients following ischemic stroke or transient ischemic attack, specifically noting CYP2C19…

Design

Review

Authors

JMJohn McDermottUniversity of Manchester MLMarc LeachUniversity of Manchester DSDwaipayan SenManchester Academic Health Science Centre

Discussion

Member takes

Implication

May identify high-risk Han-Chinese patients for alternative therapy post-TIA/IS; hypothesis-generating for genotype-guided trials.

Key Points

To evaluate the clinical role and current evidence base of CYP2C19 genotyping for directing antiplatelet therapy after an ischemic stroke or transient ischemic attack.
Reviewed available pharmacogenetic evidence linking CYP2C19 loss-of-function alleles with secondary vascular outcomes during clopidogrel therapy across diverse ancestral cohorts.
Carriers of CYP2C19 loss-of-function alleles of Han-Chinese ancestry demonstrate a significantly increased risk of recurrent vascular events when treated with clopidogrel following transient ischemic attack or ischemic stroke.
Evidence linking CYP2C19 loss-of-function alleles to adverse secondary vascular outcomes remains less certain and requires further evaluation in non-Han-Chinese populations.

Structured PICO

Does CYP2C19 genotyping to guide antiplatelet therapy reduce further vascular events in patients following ischemic stroke or TIA?

Population

Patients following ischemic stroke (IS) or transient ischemic attack (TIA), specifically noting CYP2C19 loss-of-function (LoF) allele carriers of Han-Chinese ancestry

Intervention

CYP2C19 genotyping to guide antiplatelet therapy (clopidogrel)

Outcome

Further vascular eventshard clinical

CYP2C19 genotyping can identify patients, particularly of Han-Chinese ancestry, at increased risk of recurrent vascular events when treated with clopidogrel after TIA or ischemic stroke.

Limitations

Evidence base is less certain in non-Han-Chinese populations

Cite This Study

McDermott et al. (2022) studied this question.

synapsesocial.com/papers/69d76226f182769aa8b8ae91 https://doi.org/10.1080/17512433.2022.2108401

Topics

Dual antiplatelet therapy

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The role of CYP2C19 genotyping to guide antiplatelet therapy following ischemic stroke or transient ischemic attack

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Topics

The role of CYP2C19 genotyping to guide antiplatelet therapy following ischemic stroke or transient ischemic attack

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Also Consider

Topics

Also Consider