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April 18, 2019Circulation JournalOpen Access

Association of CYP2C19 Polymorphisms With Clopidogrel Reactivity and Clinical Outcomes in Chronic Ischemic Stroke

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Why the study?

It remained unknown whether the elapsed time from stroke onset affects the relationship between CYP2C19 variants and recurrent cardiovascular events.

Do CYP2C19 variants affect the rate of composite cerebrocardiovascular events in non-acute stroke patients treated with clopidogrel?

Population

518 Japanese non-acute stroke patients treated with clopidogrel

Comparison

Extensive metabolizers vs intermediate metabolizers vs poor metabolizers

Design

Multicenter prospective cohort study

Authors

TTTomotaka TanakaHiroshima General HospitalHYHiroshi YamagamiCross-Cutting CardiologyMIMasafumi IharaNational Cerebral and Cardiovascular Center

Discussion

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Implication

CYP2C19 variants may influence clopidogrel outcomes in chronic stroke; leaves open time-from-onset effects pending RCTs.

Structured PICO

Do CYP2C19 variants affect the rate of composite cerebrocardiovascular events in non-acute stroke patients treated with clopidogrel?

P
Population
518 Japanese non-acute stroke patients treated with clopidogrel (median time from index stroke to enrollment 181 days)
I
Intervention
CYP2C19 genotype classification (extensive metabolizer, intermediate metabolizer, and poor metabolizer)
C
Comparator
Comparison among the 3 CYP2C19 metabolizer groups
O
Outcome
Composite cerebrocardiovascular events (CVEs)composite

CYP2C19 variants do not significantly affect the rate of cerebrocardiovascular events in the chronic phase of stroke among patients treated with clopidogrel, despite affecting platelet reactivity.

Cite This Study

Tanaka et al. (2019) studied this question.

synapsesocial.com/papers/6a7d31f7166e996abdd5a661https://doi.org/10.1253/circj.cj-18-1386
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Also Consider

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

  1. 1CYP2C19 Polymorphisms and Antiplatelet Effects of Clopidogrel in Acute Ischemic Stroke in China2013 · 106 citations
  2. 2Impact of CYP2C19 variant genotypes on clinical efficacy of antiplatelet treatment with clopidogrel: systematic review and meta-analysis2011 · 269 citations
  3. 3Variant recurrent risk among stroke patients with differentCYP2C19phenotypes and treated with clopidogrel2014 · 49 citations
  4. 4CYP2C19 and CES1 polymorphisms and efficacy of clopidogrel and aspirin dual antiplatelet therapy in patients with symptomatic intracranial atherosclerotic disease2015 · 32 citations
  5. 5Cytochrome P-450 Polymorphisms and Response to Clopidogrel2008 · 2,504 citations