Why the study?
Responsiveness to clopidogrel varies among patients, and it was unclear whether specific SNPs in key hepatic enzymes or the ADP receptor are associated with high-on-treatment platelet reactivity.
Are specific genetic polymorphisms in key hepatic enzymes or the ADP receptor associated with high-on-treatment platelet reactivity in patients with ischemic stroke and TIAs receiving clopidogrel?
Population
103 patients with IS and TIAs receiving clopidogrel 75 mg/day
Comparison
Carriers vs non-carriers of eight SNPs in CYP2C19, CYP3A4, NR1I2, and P2Y12
Design
Observational study
Key result
In Danish patients with ischemic stroke or TIA on 75 mg/day clopidogrel, no patients exhibited high-on-treatment platelet reactivity, although CYP2C19*2 carriers had significantly higher platelet reaction units than non-carriers (median 129 vs 74, p<0.01).
Authors
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No high-on-treatment reactivity despite higher PRU in CYP2C19*2 carriers supports standard dosing; leaves open genotyping utility in stroke/TIA.
Observational (n=103)
No
Are specific genetic polymorphisms in key hepatic enzymes or the ADP receptor associated with high-on-treatment platelet reactivity in patients with ischemic stroke and TIAs receiving clopidogrel?
Absolute Event Rate: 129% vs 74%
p-value: p=<0.01
In Danish patients with ischemic stroke or TIA, genetic polymorphisms including CYP2C19*2 do not lead to high-on-treatment platelet reactivity during long-term clopidogrel therapy.
Rath et al. (2020) conducted an observational in Ischemic stroke and transient ischemic attacks (n=103). CYP2C19*2 allele vs. Non-carriers was evaluated on Platelet reaction units (PRU) (p=<0.01). In Danish patients with ischemic stroke or TIA on 75 mg/day clopidogrel, no patients exhibited high-on-treatment platelet reactivity, although CYP2C19*2 carriers had significantly higher platelet reaction units than non-carriers (median 129 vs 74, p<0.01).
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