Ticagrelor-aspirin reduced the risk of recurrent stroke within 90 days by 47% compared to clopidogrel-aspirin in CYP2C19 loss-of-function carriers aged over 65 years with normal renal function (HR 0.53).
RCT (n=6,378)
Double-blind
1:1
Yes
Does ticagrelor-aspirin reduce the occurrence of a new stroke compared to clopidogrel-aspirin in CYP2C19 loss-of-function carriers with stroke or TIA?
In CYP2C19 loss-of-function carriers with stroke or TIA, ticagrelor-aspirin appears to benefit elderly patients with normal renal function compared to clopidogrel-aspirin.
Effect estimate: HR 0.53 (95% CI 0.33-0.85)
Absolute Event Rate: 5.8% vs 9.3%
p-value: p=0.008
OBJECTIVE: loss-of-function (LOF) carriers stratified by age and renal function. METHODS: Patients in the CHANCE-2 trial were randomized to ticagrelor-aspirin or clopidogrel-aspirin treatment. The primary efficacy outcome was occurrence of a new stroke within 90 days, while bleeding was assessed for safety. Patients were categorized based on age and estimated glomerular filtration rate (eGFR). RESULTS: = 0.04). CONCLUSIONS: Elderly patients with normal renal function appear to benefit from ticagrelor compared with clopidogrel. Both younger patients with normal renal function and those with advanced age and renal insufficiency are prone to mild bleeding.
Wu et al. (Wed,) conducted a rct in Minor ischemic stroke or high-risk TIA with CYP2C19 loss-of-function allele (n=6,378). Ticagrelor-aspirin vs. Clopidogrel-aspirin was evaluated on New stroke within 90 days (subgroup: age ≥65 years, eGFR ≥90 ml/min/1.73 m2) (HR 0.53, 95% CI 0.33-0.85, p=0.008). Ticagrelor-aspirin reduced the risk of recurrent stroke within 90 days by 47% compared to clopidogrel-aspirin in CYP2C19 loss-of-function carriers aged over 65 years with normal renal function (HR 0.53).
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