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April 4, 2025JAMA Network OpenOpen Access

The primary outcome occurred more frequently in carriers of the LOF CYP2C19 allele than in noncarriers (2.7% vs 1.6%; log-rank P = .048).

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Why the study?

Prospective trial evidence regarding the effects of CYP2C19 genotypes on clopidogrel preventing cardiovascular events in patients with acute ischemic stroke remains limited.

Does CYP2C19 loss-of-function allele carrier status increase the risk of cardiovascular events in patients with acute ischemic stroke treated with clopidogrel?

Population

2910 patients receiving clopidogrel within 72 hours of acute ischemic stroke

Comparison

CYP2C19 loss-of-function allele carriers vs noncarriers

Design

Multicenter prospective nonrandomized clinical trial

Follow-up

6 months

Authors

YJYo Han JungTSTae Jin SongJKJinkwon Kim

Discussion

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Overview

CYP2C19 genotype may refine clopidogrel prognosis in ischemic stroke; extends limited observational data but leaves clinical adoption open.

Structured PICO

Does CYP2C19 loss-of-function allele carrier status increase the risk of cardiovascular events in patients with acute ischemic stroke treated with clopidogrel?

P
Population
2,910 patients who received clopidogrel within 72 hours of experiencing an acute ischemic stroke, mean age 65.3 years, 66.3% men, South Korea (37 clinical sites).
I
Intervention
Clopidogrel treatment in carriers of the CYP2C19 loss-of-function (LOF) allele (poor or intermediate metabolizers)
C
Comparator
Clopidogrel treatment in noncarriers of the CYP2C19 LOF allele (extensive metabolizers)
O
Outcome
Composite of cardiovascular events (including ischemic or hemorrhagic stroke, myocardial infarction, or cardiovascular death) within 6 months after an ischemic strokecomposite

In patients with acute ischemic stroke treated with clopidogrel, carriers of the CYP2C19 loss-of-function allele have a significantly higher risk of subsequent cardiovascular events at 6 months compared to noncarriers.

Cite This Study

Jung et al. (2025) studied this question.

synapsesocial.com/papers/6a7d31f7166e996abdd5a65ehttps://doi.org/10.1001/jamanetworkopen.2025.0398
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Also Consider

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

  1. 1Clopidogrel preventive effect based on cytochrome P450 2C19 genotype in ischaemic stroke: protocol for multicentre observational study2020 · 3 citations
  2. 2CYP2C19 Polymorphisms and Antiplatelet Effects of Clopidogrel in Acute Ischemic Stroke in China2013 · 105 citations
  3. 3CYP2C19 polymorphisms and clopidogrel efficacy in the secondary prevention of ischemic stroke: a retrospective observational study2021 · 15 citations
  4. 4Association Between<i>CYP2C19</i>Loss-of-Function Allele Status and Efficacy of Clopidogrel for Risk Reduction Among Patients With Minor Stroke or Transient Ischemic Attack2016 · 376 citations
  5. 5Abstract WP004: CYP2C19 Loss-of-Function Alleles and Early Imaging Outcomes in Clopidogrel-Treated Acute Ischemic Stroke2026