Elevated CYP450 concentration (≥458.9 pg/mL) was significantly associated with increased clopidogrel resistance (OR 4.58) in Indonesian ischemic stroke patients, who had an overall resistance incidence of 14.3%.
Cross-Sectional (n=112)
Yes
In Indonesian ischemic stroke patients, clopidogrel resistance is relatively low (14.3%), but the risk of bleeding is high (40.2%), suggesting that clopidogrel dosing may need adjustment to mitigate bleeding risk in this population.
Odds Ratio: 4.579 (95% CI 1.375–15.252)
Absolute Event Rate: 24% vs 6.5%
p-value: p=0.008
BACKGROUND: Stroke is the second leading cause of death in the world. Clopidogrel is one of the recommended therapies for it. Disturbances in the metabolic stages of clopidogrel, such as dysregulation of cytochrome p450 (CYP450) and cytochrome P450 2C19 (CYP2C19), can cause unresponsiveness or resistance. However, studies on clopidogrel resistance related to CYP450 and CYP2C19 in Indonesia are limited. METHODS: This cross-sectional study was conducted in two hospitals over a 1-year period. All patients had a minimum of one episode of ischemic stroke. Data on demographics, clopidogrel resistance, CYP450 concentration, and CYP2C19 polymorphism were collected. In total, 112 participants were enrolled in this study. RESULTS: We found that the incidence of clopidogrel resistance was 14.3% and the bleeding risk was high (40.3 %). The number of mutations in the CYP2C19 allele *17 was 96.0%. We also found that sex, hemoglobin, and CYP450 were significantly correlated with clopidogrel resistance, and with hemoglobin and CYP450 as independent factors. Fasting blood glucose and CYP2C19 allele *3 were independent factors for CYP450. CONCLUSION: The incidence of clopidogrel resistance in the Indonesian population is low; therefore, it is not an urgent issue. An important issue in this population is the high risk for bleeding. Patient treatment should be adjusted by considering this risk.
Hidayat et al. (Tue,) conducted a cross-sectional in Ischemic stroke (n=112). CYP450 concentration ≥ 458.9 pg/mL vs. CYP450 concentration < 458.9 pg/mL was evaluated on Clopidogrel resistance (non-response) (OR 4.579, 95% CI 1.375-15.252, p=0.008). Elevated CYP450 concentration (≥458.9 pg/mL) was significantly associated with increased clopidogrel resistance (OR 4.58) in Indonesian ischemic stroke patients, who had an overall resistance incidence of 14.3%.
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